Cho Clifford S, Labow Daniel M, Tang Laura, Klimstra David S, Loeffler Agnes G, Leverson Glen E, Fong Yuman, Jarnagin William R, D'Angelica Michael I, Weber Sharon M, Blumgart Leslie H, Dematteo Ronald P
Section of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, H4/724 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792-7375, USA.
Cancer. 2008 Jul 1;113(1):126-34. doi: 10.1002/cncr.23523.
The behavior of neuroendocrine neoplasms is poorly defined, and predictors of outcome after surgical resection have yet to be identified. Consequently, guidelines for treatment remain unclear. Current pathologic classification systems do not permit meaningful discrimination of hepatic neuroendocrine neoplasms.
The authors reviewed prospectively maintained databases from 2 institutions of patients who underwent hepatic resection for neuroendocrine neoplasms between 1990 and 2006. Patient, tumor, and operative characteristics were analyzed to identify factors associated with overall survival, progression-free survival, and symptom control. Hepatic neoplasms were stratified by using a 3-tier pathologic classification system based on the number of mitotic figures and the presence of tumor necrosis that was recently validated for pancreatic neuroendocrine neoplasms.
Seventy patients were identified from the databases. Low-grade, intermediate-grade, and high-grade neoplasms were identified in 53%, 37%, and 10% of patients, respectively. After a median follow-up of 51 months, the median overall survival for all patients was 91 months, and it was 108 months when 7 patients with high-grade neuroendocrine carcinomas were excluded. Progressive disease was eventually observed in 81% of patients, and the median progression-free survival was 17 months. The median time to the onset of symptoms was 39 months for patients who presented with hormonal symptoms and 80 months for all patients. Histologic grade was associated with poorer overall and progression-free survival.
When performed in a context of aggressive multimodality therapy, long-term outcomes after partial hepatectomy for hepatic neuroendocrine neoplasms were favorable; however, disease progression was eventually observed in the majority of patients. Several oncologic variables were associated with significant differences in survival after resection. A novel pathologic classification system appears to enhance prognostic stratification of patients with hepatic neuroendocrine neoplasms.
神经内分泌肿瘤的行为特征定义不明确，手术切除后预后的预测因素尚未确定。因此，治疗指南仍不清晰。目前的病理分类系统无法对肝神经内分泌肿瘤进行有意义的区分。
作者回顾了1990年至2006年间在2家机构接受肝神经内分泌肿瘤肝切除患者的前瞻性维护数据库。分析患者、肿瘤和手术特征，以确定与总生存期、无进展生存期和症状控制相关的因素。肝肿瘤采用基于有丝分裂象数量和肿瘤坏死情况的三级病理分类系统进行分层，该系统最近已在胰腺神经内分泌肿瘤中得到验证。
从数据库中识别出70例患者。低级别、中级别和高级别肿瘤分别在53%、37%和10%的患者中被识别出。中位随访51个月后，所有患者的中位总生存期为91个月，排除7例高级别神经内分泌癌患者后为108个月。最终81%的患者出现疾病进展，中位无进展生存期为17个月。出现激素症状患者的症状发作中位时间为39个月，所有患者为80个月。组织学分级与较差的总生存期和无进展生存期相关。
在积极的多模式治疗背景下进行时，肝神经内分泌肿瘤部分肝切除术后的长期预后良好；然而，大多数患者最终出现疾病进展。几个肿瘤学变量与切除术后生存期的显著差异相关。一种新的病理分类系统似乎增强了肝神经内分泌肿瘤患者的预后分层。
