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Eur J Surg Oncol. 2017 Feb;43(2):380-387. doi: 10.1016/j.ejso.2016.10.031. Epub 2016 Nov 24.

Primary tumour resection may improve survival in functional well-differentiated neuroendocrine tumours metastatic to the liver.

Author information

1
Comprehensive ENETS Center, Medical and Surgical Oncology and Pathology, Istituto Nazionale Tumori (National Cancer Institute) IRCCS Foundation, via Venezian 1, 20133 Milan, Italy.
2
Comprehensive ENETS Center, Medical and Surgical Oncology and Pathology, Istituto Nazionale Tumori (National Cancer Institute) IRCCS Foundation, via Venezian 1, 20133 Milan, Italy; University of Milan, Italy.
3
Comprehensive ENETS Center, Medical and Surgical Oncology and Pathology, Istituto Nazionale Tumori (National Cancer Institute) IRCCS Foundation, via Venezian 1, 20133 Milan, Italy; University of Milan, Italy. Electronic address: vincenzo.mazzaferro@istitutotumori.mi.it.

Abstract

BACKGROUND:

Functional well-differentiated neuroendocrine tumours (NET) with liver metastases represent a therapeutic challenge with few alternative options in guidelines. In these patients, the role of surgical resection of the primary tumour is controversial.

PATIENTS AND METHODS:

From a regional registry collecting somatostatin analogue (SSA)-treated tumours from 1979 to 2005, a series of 139 patients presenting with symptomatic, liver-metastatic, well-differentiated NET (G1-G2, mitoses: ≤20, Ki-67: ≤20%) was prospectively collected and retrospectively analysed. Surgery on either the primary tumour or liver metastases was chosen: 1) when low perioperative risk was predictable; 2) in presence of an impending risk of obstruction, bleeding, or perforation; or 3) if liver metastases were suitable of curative or subtotal (>90%) tumour removal. Impact of the most relevant clinico-pathological parameters on survival was studied.

RESULTS:

Median follow-up was 127 months and median survival was 94 months, with 138 vs. 37 months in resected vs. non-resected primary NET (p < 0.001), respectively. In the univariate analysis, prolonged survival was significantly associated with primary tumour resection (p < 0.001), resection of liver metastases (p = 0.002), site of primary (carcinoid vs. pancreatic, p = 0.018), basal chromogranin-A (CgA) <200 ng/mL (p = 0.001), and absence of diarrhea (p = 0.012). Multivariate analysis showed that primary tumour resection was an independent positive prognostic factor (HR = 3.17; 95% CI: 1.77-5.69, p < 0.001), whereas diarrhea, basal CgA ≥200 ng/mL, and high tumour load were independent negative prognostic factors. Also, in 103 patients with non-resectable liver metastases, primary tumour resection was significantly associated with prolonged survival (median 137 vs. 32 months, p < 0.0001).

CONCLUSIONS:

Primary tumour resection may improve survival in functional well-differentiated NET with liver metastases.

KEYWORDS:

Carcinoid tumour; Liver metastases; Neuroendocrine tumours; Prognosis; Somatostatin analogues; Surgical treatment

PMID:
27956320
DOI:
10.1016/j.ejso.2016.10.031
[Indexed for MEDLINE]

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