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Am J Transplant. 2016 Oct;16(10):2892-2902. doi: 10.1111/ajt.13831. Epub 2016 Jun 9.

The Long-Term Benefit of Liver Transplantation for Hepatic Metastases From Neuroendocrine Tumors.

Author information

1
Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
2
Trial Office and Biomedical Statistics, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
3
Pathology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
4
Interventional Radiology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
5
Psychology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
6
Medical Oncology Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
7
North Italian Transplant Procurement Agency, Organ and Tissue Transplant Immunology, IRCCS Policlinico Hospital, Milan, Italy.

Abstract

Selection criteria and benefit of liver transplantation for hepatic metastases from neuroendocrine tumors (NETs) remain uncertain. Eighty-eight consecutive patients with metastatic NETs eligible for liver transplantation according to Milan-NET criteria were offered transplant (n = 42) versus nontransplant options (n = 46) depending on list dynamics, patient disposition, and age. Tumor burden between groups did not differ. Transplant patients were younger (40.5 vs. 55.5 years; p < 0.001). Long-term outcomes were compared after matching between groups made on multiple Cox models adjusted for propensity score built on logistic models. Survival benefit was the difference in mean survival between transplant versus nontransplant options. No patients were lost or died without recurrence. Median follow-up was 122 months. The transplant group showed a significant advantage over nontransplant strategies at 5 and 10 years in survival (97.2% and 88.8% vs. 50.9% and 22.4%, respectively; p < 0.001) and time-to-progression (13.1% and 13.1% vs. 83.5% and 89%; p < 0.001). After adjustment for propensity score, survival advantage of the transplant group was significant (hazard ratio = 7.4; 95% confidence interval (CI): 2.4-23.0; p = 0.001). Adjusted transplant-related survival benefit was 6.82 months (95% CI: 1.10-12.54; p = 0.019) and 38.43 months (95% CI: 21.41-55.45; p < 0.001) at 5 and 10 years, respectively. Liver transplantation for metastatic NETs under restrictive criteria provides excellent long-term outcome. Transplant-related survival benefit increases over time and maximizes after 10 years.

KEYWORDS:

cancer/malignancy/neoplasia; cancer/malignancy/neoplasia: metastatic disease; clinical research/practice; liver disease: malignant; liver transplantation/hepatology; recipient selection

PMID:
27134017
DOI:
10.1111/ajt.13831
[Indexed for MEDLINE]
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