Department of Hepatobiliary Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo City, 060-8638, Japan.
World J Surg Oncol. 2024 Aug 3;22(1):209. doi: 10.1186/s12957-024-03476-5.
Survival comparisons among patients with liver metastases from pancreatic and rectal neuroendocrine tumors (NETs) were limited, and the efficacy of observation rules in patients undergoing hepatectomy for neuroendocrine liver metastases (NELMs) was unknown. This study aims to distinguish these characteristics and clarify the effects of the observation rules on NELMs.
Clinical data were separately collected from patients with pancreatic and rectal NELMs at medical centers in both Japan and China. The Japanese cohort followed the observation rules for the resection of NELMs. A comparative analysis was conducted on clinical characteristics and prognosis features such as overall survival time (OS) and disease-free survival interval (DFS-I).
Enrollment included 47 and 34 patients from Japan and China, respectively. Of these, 69 and 12 patients had tumors originating from the pancreas and rectum, respectively. The OS time in patients undergoing primary tumor resection was significantly longer; however, the OS time between the patients undergoing and not undergoing radical resection of liver metastasis was the same. In asynchronous NELMs, patients with rectal (R)-NELMs showed a significantly higher proportion of type III NELMs. Additionally, the median DFS-I of asynchronous R-NELMs was longer than the recommended follow-up time, with 71.4% of them classified as G2. In the Japanese cohort, patients who adhered to the observation rules exhibited a longer median DFS after hepatectomy for NELMs compared with their counterparts.
Although curative surgery is crucial for primary lesions, personalized approaches are required to manage NELMs. Extended overall follow-ups and shortened follow-up intervals are recommended for G2 stage rectal NETs. The observation rules for NELMs require further validation with a larger sample size.
胰腺和直肠神经内分泌肿瘤（NETs）肝转移患者的生存比较有限，且神经内分泌肝脏转移瘤（NELMs）患者行肝切除术后的观察规则的疗效尚不清楚。本研究旨在区分这些特征，并阐明观察规则对 NELMs 的影响。
分别从日本和中国的医学中心收集胰腺和直肠 NELMs 患者的临床数据。日本队列遵循 NELMs 切除术的观察规则。对总生存时间（OS）和无病生存间隔（DFS-I）等临床特征和预后特征进行比较分析。
共纳入日本和中国的 47 例和 34 例患者，其中 69 例和 12 例患者的肿瘤来源于胰腺和直肠。行原发肿瘤切除术的患者 OS 时间明显延长，但行和未行肝转移根治性切除术的患者 OS 时间相同。在异步 NELMs 中，直肠（R）-NELMs 患者 III 型 NELMs 比例明显较高。此外，异步 R-NELMs 的中位 DFS-I 长于推荐的随访时间，其中 71.4%的患者为 G2 期。在日本队列中，与未遵守观察规则的患者相比，遵守观察规则的患者在接受 NELMs 肝切除术后的中位 DFS 更长。
尽管根治性手术对原发灶至关重要，但需要针对 NELMs 采用个体化方法。建议对 G2 期直肠 NETs 进行更长期的全面随访和缩短随访间隔。需要进一步验证 NELMs 的观察规则，样本量更大。
