Frankfurt University Hospital, Goethe University Frankfurt/Main, Department of General- and Visceral Surgery, Frankfurt am Main, Germany.
Frankfurt University Hospital, Goethe University Frankfurt/Main, Department of General- and Visceral Surgery, Frankfurt am Main, Germany.
Eur J Surg Oncol. 2019 May;45(5):808-815. doi: 10.1016/j.ejso.2018.12.022. Epub 2018 Dec 28.
It remains unclear whether liver resection as part of multimodal therapy of neuroendocrine liver metastases (NELM) is superior to non-surgical (interventional and medication-based) treatment alone. This study should determine if patients with NELM undergoing hepatic surgery in addition to non-surgical treatment have improved overall survival compared to patients undergoing non-surgical therapy alone.
123 patients undergoing treatment of NELM between 1995 and 2014 were included in this retrospective cohort study. Two groups were formed: (A) surgery and non-surgical therapy and (B) non-surgical treatment alone. To minimize the bias of patient selection propensity score matching was used.
There was significantly better overall survival for group A (152 months, 95%CI: 119-185) compared to group B (63 months, 95%CI: 45-81) measured from the initial diagnosis of the metastases (P = 0.003). After propensity score matching, 37 patients undergoing surgical resection of NELM within a multimodal treatment were compared to 37 patients undergoing non-surgical treatment. Under these circumstances, surgery had no significant influence on survival (group A: 134 months, 95% CI: 94-173; group B: 76 months, 95% CI: 53-99, P = 0.23). Based on a multivariate Cox proportional hazard model, only Ki-67 of primary tumor >20% (HR, 50.776; 95%CI, 4.056-635.71; P = 0.002) and no resection of primary tumor (HR, 10.464; 95%CI, 1.873-58.448; P = 0.007) remained independent risk factors.
After minimizing patient selection bias, patients with hepatic resection as integral of multimodal therapy of NELM do not have better overall survival than those receiving non-surgical treatment alone.
神经内分泌肝脏转移瘤（NELM）的多模态治疗中，肝切除术是否优于单纯非手术（介入和药物治疗）治疗仍不清楚。本研究旨在确定与单纯接受非手术治疗的患者相比，接受肝切除术联合非手术治疗的 NELM 患者的总生存率是否有所提高。
本回顾性队列研究纳入了 1995 年至 2014 年间接受 NELM 治疗的 123 例患者。将患者分为两组：（A）手术和非手术治疗组，（B）单纯非手术治疗组。为了最大限度地减少患者选择的偏倚，采用了倾向评分匹配。
从转移瘤的初始诊断开始，A 组（152 个月，95%CI：119-185）的总生存率明显优于 B 组（63 个月，95%CI：45-81）（P=0.003）。在进行倾向评分匹配后，将 37 例接受多模态治疗中 NELM 肝切除术的患者与 37 例接受非手术治疗的患者进行比较。在这种情况下，手术对生存没有显著影响（A 组：134 个月，95%CI：94-173；B 组：76 个月，95%CI：53-99，P=0.23）。基于多变量 Cox 比例风险模型，仅原发肿瘤 Ki-67 ＞20%（HR，50.776；95%CI，4.056-635.71；P=0.002）和未切除原发肿瘤（HR，10.464；95%CI，1.873-58.448；P=0.007）是独立的危险因素。
在最大限度地减少患者选择偏倚后，接受肝切除术作为 NELM 多模态治疗的一部分的患者的总生存率并不优于单纯接受非手术治疗的患者。
