Department of Surgery, University of Verona, Verona, Italy.
Scientific Institute San Raffaele, Milan, Italy.
J Gastrointest Surg. 2017 Dec;21(12):2039-2047. doi: 10.1007/s11605-017-3491-1. Epub 2017 Jul 25.
Neuroendocrine tumors typically arise from pancreatic (PNET) vs. gastrointestinal or thoracic origins (non-PNET). The impact of primary tumor site on long-term prognosis following resection of neuroendocrine liver metastasis (NELM) remains poorly defined. The objective of the current study was to define the association of primary tumor location on prognosis of patients undergoing curative intent liver resection for NELM.
Between 1990 and 2014, 421 patients who underwent resection of NELM were identified from a multi-institutional database. Clinicopathological characteristics, operative details, and outcomes were stratified and analyzed by location of the primary tumor (PNET vs. non-PNET). A propensity score-matched analysis was utilized to assess the impact of primary tumor location on long-term survival.
Among the 421 patients, 197 (46.8%) patients had NELM from a PNET primary while 224 (53.2%) had a non-PNET primary (small bowel, n = 145; rectal, n = 10; bronchial, n = 22; other, n = 47). There were no differences in tumor burden and tumor site, while presence of extrahepatic disease was more common among patients with non-PNET NELM (extrahepatic disease, PNET NELM, n = 11 27.5% vs. non-PNET NELM, n = 29 72.5%; p = 0.010). Patients with PNET NELM were more likely to have non-functional disease compared with patients who had non-PNET NELM (non-functional, PNET NELM, n = 117 54.9% vs. non-PNET NELM, n = 96 45.1%; p = 0.011). On the final pathological specimen of the resected NELM, patients with PNET NELM were more likely to have a moderately differentiated tumor (59.3%), while patients with non-PNET NELM were more likely to have a poorly differentiated tumor (67.8%) (p = 0.005). Patients with PNET NELM had a worse 5-year DFS and 5-year OS compared with patients who had non-PNET NELM (DFS, PNET 36.2% vs. non-PNET 55.2%; p = 0.001 and OS, PNET 79.5% vs. non-PNET 83.4%; p = 0.008). After propensity score matching, both 5-year DFS and 5-year OS of the PNET and non-PNET groups were comparable (DFS, PNET 46.2% vs. non-PNET 55.9%; p = 0.22 and OS, PNET 81.5% vs. non-PNET 84.3%; p = 0.19).
PNET patients more often present with non-functional NELM and moderately differentiated tumors. On propensity-matched analysis, factors such as extrahepatic disease and tumor grade, but not primary tumor location, were associated with prognosis of patients undergoing curative intent liver surgery for NELM.
神经内分泌肿瘤通常起源于胰腺（PNET）与胃肠道或胸部（非 PNET）。原发肿瘤部位对神经内分泌肝脏转移（NELM）切除术后长期预后的影响仍未明确。本研究旨在明确原发肿瘤位置与接受 NELM 根治性肝切除术患者预后的相关性。
1990 年至 2014 年间，从一个多机构数据库中确定了 421 例接受 NELM 切除术的患者。根据原发肿瘤的位置（PNET 与非 PNET）对临床病理特征、手术细节和结局进行分层和分析。采用倾向评分匹配分析评估原发肿瘤位置对长期生存的影响。
421 例患者中，197 例（46.8%）患者的 NELM 源自 PNET 原发肿瘤，224 例（53.2%）患者的 NELM 源自非 PNET 原发肿瘤（小肠，n=145；直肠，n=10；支气管，n=22；其他，n=47）。肿瘤负荷和肿瘤部位无差异，而非 PNET NELM 患者更常存在肝外疾病（肝外疾病，PNET NELM，n=11，27.5%；非 PNET NELM，n=29，72.5%；p=0.010）。与非 PNET NELM 患者相比，PNET NELM 患者更可能为无功能肿瘤（无功能，PNET NELM，n=117，54.9%；非 PNET NELM，n=96，45.1%；p=0.011）。在切除的 NELM 的最终病理标本中，PNET NELM 患者更可能为中分化肿瘤（59.3%），而非 PNET NELM 患者更可能为低分化肿瘤（67.8%）（p=0.005）。与非 PNET NELM 患者相比，PNET NELM 患者的 5 年无病生存率（DFS）和总生存率（OS）更差（DFS，PNET 36.2%；非 PNET 55.2%；p=0.001 和 OS，PNET 79.5%；非 PNET 83.4%；p=0.008）。在进行倾向评分匹配后，PNET 和非 PNET 组的 5 年 DFS 和 OS 相当（DFS，PNET 46.2%；非 PNET 55.9%；p=0.22 和 OS，PNET 81.5%；非 PNET 84.3%；p=0.19）。
PNET 患者更常出现无功能 NELM 和中分化肿瘤。在倾向性匹配分析中，与预后相关的因素为肝外疾病和肿瘤分级，而非原发肿瘤位置。
