Armstrong Emily A, Beal Eliza W, Shah Manisha, Konda Bhavana, Abdel-Misih Sherif, Ejaz Aslam, Dillhoff Mary E, Pawlik Timothy M, Cloyd Jordan M
The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Hepatobiliary Surg Nutr. 2020 Feb;9(1):1-12. doi: 10.21037/hbsn.2019.06.02.
Previous research has demonstrated that specific radiographic criteria, including the presence of calcifications and the enhancement pattern on computed tomography (CT) imaging, correlates with clinicopathologic features and outcomes of patients with gastroenteropancreatic neuroendocrine tumors (NET). We sought to investigate whether these radiographic characteristics were prognostic among patients with neuroendocrine liver metastases (NELM) undergoing surgical resection.
The preoperative contrast-enhanced CT scans of all patients who underwent resection of NELM at a single institution between 2000-2015 were retrospectively reviewed. The presence of calcifications was determined on non-contrast phase imaging. Enhancement on the arterial phase scan was categorized as hyperenhancing, hypoenhancing, or mixed. Relevant clinicopathologic characteristics as well as recurrence-free survival (RFS) and overall survival (OS) were compared between groups.
Among 82 patients who underwent resection of NELM, 57 had available data on calcifications while 51 had data available on arterial enhancement patterns. Among all patients, median age was 58 (IQR: 47-63) and the majority were female (N=48, 59.5%). The most common primary tumor locations were pancreas (N=25, 30.5%) and small bowel (N=27, 32.9%). The most commonly performed operations were right hepatectomy (N=29, 35.4%), bisegmentectomy (N=15, 18.3%), and segmentectomy (N=14, 17.1%). Median tumor number was 4 (IQR: 2-9), median Ki-67 was 5% (IQR: 2-10%), and median size of the largest liver metastasis was 4.5 (IQR: 2.8-7.7) cm. Twelve (21%) patients had tumor calcifications. Among patients with and without calcifications there were no differences in demographics, clinicopathologic characteristics, RFS (P=0.772) or OS (P=0.095). Arterial enhancement was hypoenhancing in 23 (45.1%), hyperenhancing in 10 (19.6%), and mixed in 18 (35.3%). Similarly, there were no differences between arterial enhancement groups in demographics, clinicopathologic characteristics, RFS (P=0.618) or OS (P=0.268).
Radiographic characteristics on contrast-enhanced CT are not associated with the outcomes of patients undergoing resection of NELM. Future investigations should evaluate the prognostic impact of functional neuroendocrine imaging.
先前的研究表明，特定的影像学标准，包括钙化的存在以及计算机断层扫描（CT）成像上的强化模式，与胃肠胰神经内分泌肿瘤（NET）患者的临床病理特征和预后相关。我们试图研究这些影像学特征对于接受手术切除的神经内分泌肝转移（NELM）患者是否具有预后价值。
回顾性分析了2000年至2015年间在单一机构接受NELM切除的所有患者的术前增强CT扫描。在平扫期成像上确定钙化的存在。动脉期扫描的强化分为高强化、低强化或混合强化。比较各组之间的相关临床病理特征以及无复发生存期（RFS）和总生存期（OS）。
在82例接受NELM切除的患者中，57例有关于钙化的数据，51例有关于动脉期强化模式的数据。在所有患者中，中位年龄为58岁（四分位间距：47 - 63岁），大多数为女性（N = 48，59.5%）。最常见的原发肿瘤部位是胰腺（N = 25，30.5%）和小肠（N = 27，32.9%）。最常进行的手术是右肝切除术（N = 29，35.4%）、双段切除术（N = 15，18.3%）和段切除术（N = 14，17.1%）。中位肿瘤数量为4个（四分位间距：2 - 9个），中位Ki-67为5%（四分位间距：2 - 10%），最大肝转移灶的中位大小为4.5（四分位间距：2.8 - 7.7）cm。12例（21%）患者有肿瘤钙化。有钙化和无钙化的患者在人口统计学、临床病理特征、RFS（P = 0.772）或OS（P = 0.095）方面无差异。动脉期强化为低强化的有23例（45.1%），高强化的有10例（19.6%），混合强化的有18例（35.3%）。同样，动脉期强化组在人口统计学、临床病理特征、RFS（P = 0.618）或OS（P = 0.268）方面也无差异。
增强CT上的影像学特征与接受NELM切除的患者的预后无关。未来的研究应评估功能性神经内分泌成像的预后影响。
