Moris Dimitrios, Tsilimigras Diamantis I, Ntanasis-Stathopoulos Ioannis, Beal Eliza W, Felekouras Evangelos, Vernadakis Spiridon, Fung John J, Pawlik Timothy M
Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH.
First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Surgery. 2017 Sep;162(3):525-536. doi: 10.1016/j.surg.2017.05.006. Epub 2017 Jun 16.
Liver transplantation to treat neuroendocrine tumors, especially in the setting of diffuse liver involvement not amenable to operative resection remains controversial. We sought to perform a systematic review of the current literature to summarize data on patients undergoing liver transplantation with neuroendocrine tumors liver metastases as the indication.
A systematic review was conducted in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Eligible studies were identified using 3 distinct databases through March 2017: Medline (PubMed), ClinicalTrials.gov, and Cochrane library, Cochrane Central Register of Controlled Trials using a search algorithm: "(neuroendocrine or NET) and transplantation and liver."
From the 1,216 records retrieved, 64 studies were eligible. Overall, 4 studies presented data from registries, namely the European Liver Transplant Registry and the United Network for Organ Transplantation/Organ Procurement and Transplantation Network databases, 3 were multicenter studies. The largest cohort of data on patients undergoing liver transplantation for neuroendocrine tumors liver metastasis indication were from single center studies comprising a total of 279 patients. Pancreas was the primary tumor site for most patients followed by the ileum. Several studies reported that more than half of patients presented with synchronous disease (55.9% and 57.7%); in contrast, metachronous neuroendocrine tumors liver metastasis ranged from 17.7% to 38.7%. Overall, recurrence after liver transplantation ranged from 31.3% to 56.8%. Reported 1-, 3-, and 5-year overall survival was 89%, 69%, and 63%, respectively. Several prognostic factors associated with worse long-term survival including transplantation >50% liver tumor involvement, high Ki67, as well as a pancreatic neuroendocrine tumors versus gastrointestinal neuroendocrine tumors tumor location.
Liver transplantation may provide a survival benefit among patients with diffuse neuroendocrine tumors metastases to the liver. However, due to high recurrence rates, strict selection of patients is critical. Due to the scarcity of available grafts and the lack of level 1 evidence, the recommendations to endorse liver transplantation for extensive liver neuroendocrine tumors metastases warrants ongoing deliberations.
肝移植用于治疗神经内分泌肿瘤，尤其是在弥漫性肝脏受累且无法进行手术切除的情况下仍存在争议。我们试图对当前文献进行系统综述，以总结以神经内分泌肿瘤肝转移为指征接受肝移植患者的数据。
按照系统评价和Meta分析的首选报告项目指南进行系统综述。通过使用搜索算法“（神经内分泌或NET）和移植和肝脏”，在2017年3月前通过3个不同的数据库确定符合条件的研究：Medline（PubMed）、ClinicalTrials.gov和Cochrane图书馆、Cochrane对照试验中央注册库。
从检索到的1216条记录中，有64项研究符合条件。总体而言，4项研究提供了来自登记处的数据，即欧洲肝移植登记处和器官移植联合网络/器官获取与移植网络数据库，3项是多中心研究。以神经内分泌肿瘤肝转移为指征接受肝移植患者的最大数据集来自单中心研究，共有279例患者。大多数患者的原发肿瘤部位是胰腺，其次是回肠。几项研究报告说，超过一半的患者出现同时性疾病（55.9%和57.7%）；相比之下，异时性神经内分泌肿瘤肝转移的比例在17.7%至38.7%之间。总体而言，肝移植后的复发率在31.3%至56.8%之间。报告的1年、3年和5年总生存率分别为89%、69%和63%。几个与较差长期生存相关的预后因素包括移植时肝脏肿瘤累及>50%、高Ki67，以及胰腺神经内分泌肿瘤与胃肠道神经内分泌肿瘤的肿瘤位置。
肝移植可能为弥漫性神经内分泌肿瘤肝转移患者带来生存益处。然而，由于复发率高，严格选择患者至关重要。由于可用移植物稀缺且缺乏一级证据，支持对广泛肝神经内分泌肿瘤转移进行肝移植的建议值得持续商讨。
