Bagante Fabio, Spolverato Gaya, Merath Katiuscha, Postlewait Lauren McLendon, Poultsides George A, Mullen Matthew G, Bauer Todd W, Fields Ryan C, Lamelas Jorge, Marques Hugo P, Aldrighetti Luca, Tran Thuy, Maithel Shishir K, Pawlik Timothy M
Department of Surgery, University of Verona, Verona, Italy.
Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
J Surg Oncol. 2017 May;115(6):687-695. doi: 10.1002/jso.24563. Epub 2017 Feb 1.
Neuroendocrine liver metastasis tumors (NELM) are a heterogeneous group of neoplasms with varied histologic features and a wide range of clinical behaviors. We aimed to identify the fraction of patients cured after liver surgery for NELM.
Cure fraction models were used to analyze 376 patients who underwent hepatectomy with curative intent for NELM.
The median and 5-year disease-free survival (DFS) were 4.5 years and 46%, respectively. The probability of being cured from NELM by liver surgery was 44%; the time to cure was 5.1 years. In a multivariable cure model, type of neuroendocrine tumor (NET), grade of tumor differentiation, and rate of liver involvement resulted as independent predictors of cure. The cure fraction for patients with well differentiated NELM from gastrointestinal NET or a functional pancreatic NET, and with <50% of liver-involvement was 95%. Patients who had moderately/poorly differentiated NELM from a non-functional pancreatic NET, and with <50% of liver-involvement was 43%. In the presence of all the three unfavorable prognostic factors (nonfunctional PNET, liver involvement >50%, moderately/poorly differentiation), the cure fraction was 8%.
Statistical cure after surgery for NELM is possible, and allow for a more accurate prediction of long-term outcome among patients with NELM undergoing liver resection.
神经内分泌肝脏转移瘤（NELM）是一组异质性肿瘤，具有多样的组织学特征和广泛的临床行为。我们旨在确定接受肝脏手术治疗的NELM患者的治愈比例。
采用治愈比例模型分析376例接受根治性肝切除术治疗NELM的患者。
中位无病生存期和5年无病生存期（DFS）分别为4.5年和46%。肝脏手术治愈NELM的概率为44%；治愈时间为5.1年。在多变量治愈模型中，神经内分泌肿瘤（NET）类型、肿瘤分化程度和肝脏受累率是治愈的独立预测因素。来自胃肠道NET或功能性胰腺NET且肝脏受累<50%的高分化NELM患者的治愈比例为95%。来自非功能性胰腺NET且肝脏受累<50%的中/低分化NELM患者的治愈比例为43%。存在所有三个不利预后因素（非功能性PNET、肝脏受累>50%、中/低分化）时，治愈比例为8%。
NELM手术后实现统计学治愈是可能的，这有助于更准确地预测接受肝切除的NELM患者的长期预后。
