Kaçmaz Enes, Heidsma Charlotte M, Besselink Marc G H, Dreijerink Koen M A, Klümpen Heinz-Josef, Nieveen van Dijkum Elisabeth J M, Engelsman Anton F
Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV, The Netherlands.
J Clin Med. 2019 Mar 22;8(3):403. doi: 10.3390/jcm8030403.
Strong evidence comparing different treatment options for liver metastases (LM) arising from gastroenteropancreatic neuroendocrine tumours (GEP-NET) is lacking. The aim of this study was to determine which intervention for LMs from GEP-NETs shows the longest overall survival (OS). A systematic search was performed in MEDLINE, Embase and the Cochrane Library in February 2018. Studies reporting on patients with LMs of any grade of sporadic GEP-NET comparing two intervention groups were included for analysis. Meta-analyses were performed where possible. Eleven studies, with a total of 1108, patients were included; 662 patients had LM from pancreatic NETs (pNET), 164 patients from small-bowel NETs (SB-NET) and 282 patients of unknown origin. Improved 5-year OS was observed for surgery vs. chemotherapy (OR .05 95% CI [0.01, 0.21] < 0.0001), for surgery vs. embolization (OR 0.18 95% CI [0.05, 0.61] = 0.006) and for LM resection vs. no LM resection (OR 0.15 95% CI [0.05, 0.42] = 0.0003). This is the largest meta-analysis performed comparing different interventions for LMs from GEP-NETs. Despite the high risk of bias and heterogeneity of data, surgical resection for all tumour grades results in the longest overall survival. Chemotherapy and embolization should be considered as an alternative in case surgery is not feasible.
目前缺乏关于胃肠胰神经内分泌肿瘤（GEP-NET）肝转移（LM）不同治疗方案比较的有力证据。本研究的目的是确定针对GEP-NET肝转移的哪种干预措施能显示出最长的总生存期（OS）。2018年2月在MEDLINE、Embase和Cochrane图书馆进行了系统检索。纳入分析的研究报告了比较两个干预组的任何级别的散发性GEP-NET肝转移患者情况。尽可能进行了荟萃分析。共纳入11项研究，1108例患者；662例患者为胰腺神经内分泌肿瘤（pNET）肝转移，164例患者为小肠神经内分泌肿瘤（SB-NET）肝转移，282例患者来源不明。与化疗相比，手术组5年总生存期改善（OR 0.05，95%CI[0.01, 0.21]，<0.0001）；与栓塞术相比，手术组改善（OR 0.18，95%CI[0.05, 0.61]，=0.006）；与未进行肝转移灶切除相比，肝转移灶切除组改善（OR 0.15，95%CI[0.05, 0.42]，=0.0003）。这是针对GEP-NET肝转移不同干预措施进行比较的最大规模荟萃分析。尽管存在高偏倚风险和数据异质性，但对所有肿瘤分级进行手术切除可获得最长总生存期。若手术不可行，化疗和栓塞术可作为替代方案考虑。
