Galleberg R B, Knigge U, Tiensuu Janson E, Vestermark L W, Haugvik S-P, Ladekarl M, Langer S W, Grønbæk H, Österlund P, Hjortland G O, Assmus J, Tang L, Perren A, Sorbye H
Department of Oncology, Haukeland University Hospital, Bergen, Norway.
Departments of Surgery C and Endocrinology PE, Rigshospitalet, University of Copenhagen, Denmark.
Eur J Surg Oncol. 2017 Sep;43(9):1682-1689. doi: 10.1016/j.ejso.2017.04.010. Epub 2017 May 4.
Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce. The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC.
32 patients with a diagnosis of high-grade gastroenteropancreatic neuroendocrine neoplasm (Ki-67 > 20%) and with intended curative resection/RFA of liver metastases, were identified among 840 patients from two Nordic GEP-NEC registries. Tumor morphology (well vs poor differentiation) was reassessed. Overall survival (OS) and progression-free survival (PFS) was assessed by Kaplan-Meier analyses for the entire cohort and for subgroups.
Median OS after resection/RFA of liver metastases was 35.9 months (95%-CI: 20.6-51.3) with a five-year OS of 43%. The median PFS was 8.4 months (95%-CI: 3.9-13). Four patients (13%) were disease-free after 5 years. Two patients had well-differentiated morphology (NET G3) and 20 patients (63%) had Ki-67 ≥ 55%. A Ki-67 < 55% and receiving adjuvant chemotherapy were statistically significant factors of improved OS after liver resection/RFA.
This study shows a long median and long term survival after liver surgery/RFA for these selected metastatic GEP-NEC patients, particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population.
胃肠胰神经内分泌癌（GEP-NEC）通常具有同步转移、高侵袭性和预后不良的特点。目前的国际指南不推荐对肝转移灶进行手术治疗，然而现有数据较少。本研究的目的是评估转移性GEP-NEC患者肝转移灶根治性切除/射频消融（RFA）的结果。
在来自两个北欧GEP-NEC登记处的840例患者中，确定了32例诊断为高级别胃肠胰神经内分泌肿瘤（Ki-67>20%）且计划对肝转移灶进行根治性切除/RFA的患者。重新评估肿瘤形态（高分化与低分化）。通过Kaplan-Meier分析评估整个队列及亚组的总生存期（OS）和无进展生存期（PFS）。
肝转移灶切除/RFA后的中位OS为35.9个月（95%置信区间：20.6-51.3），5年OS率为43%。中位PFS为8.4个月（95%置信区间：3.9-13）。4例患者（13%）5年后无疾病。2例患者肿瘤形态为高分化（NET G3），20例患者（63%）Ki-67≥55%。Ki-67<55%且接受辅助化疗是肝切除/RFA后OS改善的统计学显著因素。
本研究表明，对于这些选定的转移性GEP-NEC患者，肝手术/RFA后有较长的中位生存期和长期生存率，特别是对于Ki-67处于相对较低G3范围的患者组。我们的研究结果表明，肝转移灶的手术治疗在该患者群体的管理中可能具有作用。
