Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Ann Surg Oncol. 2018 Dec;25(13):3928-3935. doi: 10.1245/s10434-018-6751-8. Epub 2018 Sep 14.
The objective of this study was to assess the impact of unresected primary tumor, as well as extrahepatic metastasis, on the long-term prognosis of patients undergoing hepatic resection for non-functional neuroendocrine liver metastasis (NF-NELM).
Patients who underwent hepatic resection for NF-NELM were identified from a multi-institutional database. Data on clinical and pathological details, as well as the long-term overall survival (OS) were obtained and compared. Propensity score matching was performed to generate matched pairs of patients.
Among the 332 patients with NF-NELM, 281 (84.6%) underwent primary tumor resection, while 51 (15.4%) did not. Patients who underwent primary resection were more likely to have a pancreatic primary and metachronous NELM. The long-term OS of patients who did and did not have the primary neuroendocrine tumor (NET) resected was comparable on both unmatched (10-year survival rate 66.8% vs. 54.0%, p = 0.192) and matched (10-year survival rate 75.7% vs. 60.4%, p = 0.271) analyses. In contrast, patients with NF-NELM and extrahepatic metastasis had a worse OS following resection compared with patients who had intrahepatic-only metastasis on unmatched (10-year survival rate 37.5% vs. 69.3%, p = 0.002) and matched (10-year survival rate 37.5% vs. 86.3%, p = 0.011) analyses. On multivariable analysis, while resection of the primary NET was not associated with OS (hazard ratio [HR] 0.7, 95% confidence interval [CI] 0.4-1.2, p = 0.195), the presence of extrahepatic metastasis was independently associated with long-term risk of death (HR 3.9, 95% CI 1.7-9.2, p = 0.002).
While surgery should be considered for patients with NF-NELM who have an unresectable primary tumor, operative resection of NF-NELM may not be as beneficial in patients with extrahepatic disease.
本研究旨在评估未切除原发肿瘤和肝外转移对接受肝切除术治疗非功能性神经内分泌肝脏转移（NF-NELM）患者长期预后的影响。
从一个多机构数据库中确定接受 NF-NELM 肝切除术的患者。获取并比较了临床和病理细节以及长期总生存率（OS）的数据。进行倾向评分匹配以生成配对患者。
在 332 例 NF-NELM 患者中，281 例（84.6%）接受了原发肿瘤切除术，而 51 例（15.4%）未接受。接受原发切除术的患者更有可能具有胰腺原发肿瘤和异时性 NELM。在未匹配（10 年生存率 66.8% vs. 54.0%，p=0.192）和匹配（10 年生存率 75.7% vs. 60.4%，p=0.271）分析中，切除原发神经内分泌肿瘤（NET）的患者和未切除原发 NET 的患者的长期 OS 相当。相比之下，在未匹配（10 年生存率 37.5% vs. 69.3%，p=0.002）和匹配（10 年生存率 37.5% vs. 86.3%，p=0.011）分析中，NF-NELM 患者伴肝外转移与单纯肝内转移患者相比，肝切除术后 OS 更差。多变量分析显示，尽管切除原发 NET 与 OS 无关（风险比 [HR] 0.7，95%置信区间 [CI] 0.4-1.2，p=0.195），但肝外转移的存在与长期死亡风险独立相关（HR 3.9，95%CI 1.7-9.2，p=0.002）。
虽然对于无法切除原发肿瘤的 NF-NELM 患者应考虑手术，但对于伴有肝外疾病的 NF-NELM 患者，手术切除可能不会带来益处。
