Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Surgery, State Hospital Wiener Neustadt, Wiener Neustadt, Austria.
Ann Surg Oncol. 2024 Aug;31(8):4931-4941. doi: 10.1245/s10434-024-15374-x. Epub 2024 May 8.
Surgical cytoreduction for neuroendocrine tumor liver metastasis (NETLM) consistently shows positive long-term outcomes. Despite reservations in guidelines for surgery when the primary tumor is unidentified (UP-NET), this study compared the surgical and oncologic long-term outcomes between patients with these rare cases undergoing cytoreductive surgery and patients who had liver resection for known primaries.
The study identified 32 unknown primary liver metastases (UP-NETLM) in 522 retrospectively evaluated patients who underwent resection of well-differentiated NETLM between January 2000 and December 2020. Tumor and patient characteristics were compared with those in 490 cases of liver metastasis from small intestinal (SI-NETLM) or pancreatic (pNETLM) primaries. Survival analysis was performed to highlight long-term outcome differences. Surgical outcomes were compared between liver resections alone and simultaneous primary resections to assess surgical risk distinctions.
The UP-NET patients had fewer NETLMs (p = 0.004), which on the average were larger than SI-NETLMs or pNETLMs (p = 0.002). Expression of Ki-67 was balanced among the groups. Major hepatectomy was performed more often in the UP-NETLM group (p = 0.017). The 10-year survival rate of 53% for UP-NETLM was comparable with that for SI-NETML (58%; p = 0.463) and pNETLMs (47%; p = 0.497). The median hepatic progression-free survival was 26 months for the UP-NETLM patients and 25 months for the SI-NETLM patients compared to 12 months for the pNETLM patients (p < 0.001). Perioperative mortality was lower than 2%, and severe postoperative morbidity occurred in 21%, similarly distributed among all the groups.
The surgical risk and long-term outcomes for the UP-NETLM patients were comparable with those for other NETLM cases, affirming the validity of equally aggressive surgical cytoreduction as a therapeutic option in carefully selected cases.
神经内分泌肿瘤肝转移（NETLM）的手术细胞减灭术始终显示出积极的长期结果。尽管指南对原发肿瘤未确定（UP-NET）时的手术持保留态度，但本研究比较了这些罕见病例接受细胞减灭术的患者与因已知原发肿瘤而行肝切除术的患者的手术和肿瘤学长期结果。
本研究纳入了 2000 年 1 月至 2020 年 12 月间接受分化良好的 NETLM 切除术的 522 例回顾性评估患者中的 32 例不明原发肝转移（UP-NETLM）。比较了肿瘤和患者特征，并与 490 例来自小肠（SI-NETLM）或胰腺（pNETLM）原发肿瘤的肝转移患者进行了比较。进行生存分析以突出长期结果差异。单独进行肝切除术与同时进行原发灶切除术的手术结果进行了比较，以评估手术风险差异。
UP-NET 患者的 NETLM 数量较少（p = 0.004），平均而言，这些 NETLM 比 SI-NETLM 或 pNETLM 更大（p = 0.002）。各组的 Ki-67 表达平衡。UP-NETLM 组更常进行大肝切除术（p = 0.017）。UP-NETLM 的 10 年生存率为 53%，与 SI-NETLM（58%；p = 0.463）和 pNETLM（47%；p = 0.497）相当。UP-NETLM 患者的中位肝无进展生存期为 26 个月，SI-NETLM 患者为 25 个月，而 pNETLM 患者为 12 个月（p < 0.001）。围手术期死亡率低于 2%，严重术后发病率为 21%，在所有组中分布相似。
UP-NETLM 患者的手术风险和长期结果与其他 NETLM 病例相当，证实了在仔细选择的病例中同样积极的手术细胞减灭术作为治疗选择的有效性。
