Morgan Rosemary E, Pommier SuEllen J, Pommier Rodney F
Department of Surgery, Oregon Health & Science University, Portland, OR.
Department of Surgery, Oregon Health & Science University, Portland, OR; Division of Surgical Oncology, Oregon Health & Science University, Portland, OR.
Surgery. 2018 Jan;163(1):218-225. doi: 10.1016/j.surg.2017.05.030. Epub 2017 Nov 2.
Recently, there has been a move toward decreasing the threshold for liver debulking for metastatic carcinoid tumors from 90% to 70%. The debulking threshold and factors that predict outcomes of liver debulking operations specifically among pancreatic neuroendocrine tumors are not well defined.
Records of patients with pancreatic neuroendocrine tumors undergoing liver debulking with a threshold of 70% from 2006 to 2016 were reviewed. Extrahepatic metastases and positive margins by enucleation were allowed. Liver progression-free survival and overall survival were calculated by the Kaplan-Meier method for various factors and compared by log-rank. Factors also were correlated with liver progression-free survival and overall survival by multivariate regression analyses.
Forty-two patients underwent 44 operations, of which 24 resulted in 100% debulking, 12 resulted in ≥90% debulking, and 8 resulted in ≥70% debulking. Median liver progression-free survival was 11 months. The 5-year overall survival rate was 81%. There were no significant differences in outcome based on percent debulked. Only liver metastasis ≥5 cm correlated with liver progression-free survival and overall survival.
Consideration should be given to expanding the criteria for liver debulking in pancreatic neuroendocrine tumors to include a new threshold of >70% debulking, intermediate grade tumors, positive margins, and extrahepatic metastases; these criteria yield results indistinguishable from complete resection. Using these expanded criteria will increase the number of patients eligible for an operation and maintain high survival rates.
最近，转移性类癌瘤肝减瘤的阈值已从90%降至70%。具体在胰腺神经内分泌肿瘤中，肝减瘤的阈值以及预测肝减瘤手术结果的因素尚未明确界定。
回顾了2006年至2016年期间接受阈值为70%肝减瘤的胰腺神经内分泌肿瘤患者的记录。允许存在肝外转移和剜除术切缘阳性的情况。采用Kaplan-Meier法计算各种因素的无肝进展生存期和总生存期，并通过对数秩检验进行比较。还通过多因素回归分析将这些因素与无肝进展生存期和总生存期进行相关性分析。
42例患者接受了44次手术，其中24例实现了100%减瘤，12例实现了≥90%减瘤，8例实现了≥70%减瘤。无肝进展生存期的中位数为11个月。5年总生存率为81%。基于减瘤百分比的结果无显著差异。仅肝转移灶≥5 cm与无肝进展生存期和总生存期相关。
应考虑扩大胰腺神经内分泌肿瘤肝减瘤的标准，纳入新的阈值>70%减瘤、中级别肿瘤、切缘阳性和肝外转移；这些标准产生的结果与完全切除无异。采用这些扩大后的标准将增加符合手术条件的患者数量，并维持高生存率。
