Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
Trial Office and Biomedical Statistics, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
Am J Transplant. 2016 Oct;16(10):2892-2902. doi: 10.1111/ajt.13831. Epub 2016 Jun 9.
Selection criteria and benefit of liver transplantation for hepatic metastases from neuroendocrine tumors (NETs) remain uncertain. Eighty-eight consecutive patients with metastatic NETs eligible for liver transplantation according to Milan-NET criteria were offered transplant (n = 42) versus nontransplant options (n = 46) depending on list dynamics, patient disposition, and age. Tumor burden between groups did not differ. Transplant patients were younger (40.5 vs. 55.5 years; p < 0.001). Long-term outcomes were compared after matching between groups made on multiple Cox models adjusted for propensity score built on logistic models. Survival benefit was the difference in mean survival between transplant versus nontransplant options. No patients were lost or died without recurrence. Median follow-up was 122 months. The transplant group showed a significant advantage over nontransplant strategies at 5 and 10 years in survival (97.2% and 88.8% vs. 50.9% and 22.4%, respectively; p < 0.001) and time-to-progression (13.1% and 13.1% vs. 83.5% and 89%; p < 0.001). After adjustment for propensity score, survival advantage of the transplant group was significant (hazard ratio = 7.4; 95% confidence interval (CI): 2.4-23.0; p = 0.001). Adjusted transplant-related survival benefit was 6.82 months (95% CI: 1.10-12.54; p = 0.019) and 38.43 months (95% CI: 21.41-55.45; p < 0.001) at 5 and 10 years, respectively. Liver transplantation for metastatic NETs under restrictive criteria provides excellent long-term outcome. Transplant-related survival benefit increases over time and maximizes after 10 years.
神经内分泌肿瘤（NET）肝转移患者行肝移植的选择标准和获益仍不确定。根据米兰 NET 标准，88 例符合肝移植条件的转移性 NET 患者（n = 42）可选择移植（n = 46）或非移植方案。两组患者的肿瘤负荷无差异。移植组患者更年轻（40.5 岁 vs. 55.5 岁；p < 0.001）。采用多 Cox 模型匹配后，比较两组患者的长期结局，该模型调整了基于逻辑模型构建的倾向性评分。移植组患者的生存获益是移植与非移植方案之间的平均生存差异。无失访和无复发生存终点。中位随访时间为 122 个月。移植组患者的 5 年和 10 年生存率（97.2%和 88.8% vs. 50.9%和 22.4%；p < 0.001）和无进展生存时间（13.1%和 13.1% vs. 83.5%和 89%；p < 0.001）均显著优于非移植组。校正倾向性评分后，移植组的生存优势仍显著（风险比 = 7.4；95%置信区间：2.4-23.0；p = 0.001）。校正后，移植相关生存获益为 6.82 个月（95%置信区间：1.10-12.54；p = 0.019）和 38.43 个月（95%置信区间：21.41-55.45；p < 0.001），分别在 5 年和 10 年时达到。严格条件下，肝移植治疗转移性 NET 可获得极好的长期结局。移植相关生存获益随时间增加，10 年后达到最大。
