Dousset B, Saint-Marc O, Pitre J, Soubrane O, Houssin D, Chapuis Y
Clinique Chirurgicale, Hôpital Cochin, 75679 Paris Cedex 14, France.
World J Surg. 1996 Sep;20(7):908-14; discussion 914-5. doi: 10.1007/s002689900138.
We reviewed our experience with 34 patients with metastatic endocrine tumors (METs) who were treated by different modalities. Eight patients were treated by chemotherapy or chemoembolization because of stable disease or surgical contraindications. Seventeen patients underwent curative or cytoreductive surgical resection. Nine patients received grafts based on the following criteria: no extrahepatic spread on imaging workup and nonresectable symptomatic metastatic disease. Of the eight medically treated patients, the five patients with initial stable clinical condition are alive 32 to 56 months after referral. Of the 17 patients treated by liver resection, 13 are alive 6 to 108 months after surgery, and 7 are disease-free. After curative resection, the 5-year actuarial survival and disease-free survival rates were 62% and 52%, respectively. Of the nine grafted patients, three patients grafted for carcinoid tumor are alive at 15, 24, and 62 months, one of whom has a late recurrence. Our results indicate that therapeutic indications for METs should be based on age, clinical symptoms, histologic type, and tumor extension: Patients with stable MET may benefit from surgical restraint; liver resection in patients with aggressive MET may provide good long-term palliation and possibly cure one-third of the patients; liver transplantation should be restricted to young patients with nonresectable carcinoid MET but remains a high-risk operation because of previous surgery and chemoembolization.
我们回顾了34例接受不同治疗方式的转移性内分泌肿瘤（METs）患者的治疗经验。8例患者因病情稳定或存在手术禁忌证而接受化疗或化疗栓塞治疗。17例患者接受了根治性或减瘤性手术切除。9例患者根据以下标准接受了移植：影像学检查未发现肝外转移且存在不可切除的有症状转移性疾病。在8例接受药物治疗的患者中，5例初始临床状况稳定的患者在转诊后32至56个月仍存活。在17例接受肝切除的患者中，13例在术后6至108个月仍存活，7例无疾病复发。根治性切除术后，5年实际生存率和无病生存率分别为62%和52%。在9例接受移植的患者中，3例因类癌肿瘤接受移植的患者分别在15、24和62个月时仍存活，其中1例出现晚期复发。我们的结果表明，METs的治疗指征应基于年龄、临床症状、组织学类型和肿瘤范围：MET病情稳定的患者可能从手术限制中获益；侵袭性MET患者的肝切除可能提供良好的长期缓解，并可能治愈三分之一的患者；肝移植应仅限于不可切除的类癌MET的年轻患者，但由于既往手术和化疗栓塞，其仍然是一项高风险手术。
