Ejaz Aslam, Reames Bradley N, Maithel Shishir, Poultsides George A, Bauer Todd W, Fields Ryan C, Weiss Matthew J, Marques Hugo P, Aldrighetti Luca, Pawlik Timothy M
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Department of Surgery, Emory University, Atlanta, GA, USA.
HPB (Oxford). 2018 Mar;20(3):277-284. doi: 10.1016/j.hpb.2017.08.039. Epub 2017 Sep 28.
Management of neuroendocrine liver metastasis (NELM) in the setting of unresectable disease is poorly defined and the role of debulking remains controversial. The objective of the current study was to define outcomes following non-curative intent liver-directed therapy (debulking) among patients with NELM.
612 patients were identified who underwent liver-directed therapy of NELM from a multi-institutional database. Outcomes were stratified according to curative (R0/R1) versus non-curative ≥ 80% debulking (R2).
179 (29.2%) patients had an R2/debulking procedure. Patients undergoing debulking more commonly had more aggressive high-grade tumors (R0/R1: 12.8% vs. R2: 35.0%; P < 0.001) or liver disease burden that was bilateral (R0/R1: 52.8% vs. R2: 75.6%; P < 0.001). After a median follow-up of 51 months, median (R0/R1: not reached vs. R2: 87 months; P < 0.001) and 5-year survival (R0/R1: 85.2% vs. R2: 60.7%; P < 0.001) was higher among patients who underwent an R0/R1 resection compared with patients who underwent a debulking operation. Among patients with ≥50% NELM liver involvement, median and 5-year survival following debulking was 55.4 months and 40.6%, respectively.
Debulking operations for NELM provided reasonable long-term survival. Hepatic debulking for patients with NELM is a reasonable therapeutic option for patients with grossly unresectable disease that may provide a survival benefit.
不可切除疾病背景下神经内分泌肝转移（NELM）的管理定义不明确，减瘤手术的作用仍存在争议。本研究的目的是明确NELM患者接受非根治性肝导向治疗（减瘤手术）后的结局。
从一个多机构数据库中识别出612例接受NELM肝导向治疗的患者。结局根据根治性（R0/R1）与非根治性≥80%减瘤（R2）进行分层。
179例（29.2%）患者接受了R2/减瘤手术。接受减瘤手术的患者更常患有侵袭性更强的高级别肿瘤（R0/R1：12.8% vs. R2：35.0%；P<0.001）或双侧肝脏疾病负担（R0/R1：52.8% vs. R2：75.6%；P<0.001）。中位随访51个月后，接受R0/R1切除的患者的中位生存期（R0/R1：未达到 vs. R2：87个月；P<0.001）和5年生存率（R0/R1：85.2% vs. R2：60.7%；P<0.001）高于接受减瘤手术的患者。在NELM肝脏受累≥50%的患者中，减瘤手术后的中位生存期和5年生存率分别为55.4个月和40.6%。
NELM的减瘤手术提供了合理的长期生存。对于患有严重不可切除疾病的患者，NELM的肝脏减瘤手术是一种合理的治疗选择，可能带来生存获益。
