Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas Journal Article

Authors: Galleberg, R. B.; Knigge, U.; Janson, E. T.; Vestermark, L. W.; Haugvik, S. P.; Ladekarl, M.; Langer, S. W.; Grønbæk, H.; Österlund, P.; Hjortland, G. O.; Assmus, J.; Tang, L.; Perren, A.; Sorbye, H.
Article Title: Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas
Abstract: Background Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce. The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC. Methods 32 patients with a diagnosis of high-grade gastroenteropancreatic neuroendocrine neoplasm (Ki-67 > 20%) and with intended curative resection/RFA of liver metastases, were identified among 840 patients from two Nordic GEP-NEC registries. Tumor morphology (well vs poor differentiation) was reassessed. Overall survival (OS) and progression-free survival (PFS) was assessed by Kaplan–Meier analyses for the entire cohort and for subgroups. Results Median OS after resection/RFA of liver metastases was 35.9 months (95%-CI: 20.6–51.3) with a five-year OS of 43%. The median PFS was 8.4 months (95%-CI: 3.9–13). Four patients (13%) were disease-free after 5 years. Two patients had well-differentiated morphology (NET G3) and 20 patients (63%) had Ki-67 ≥ 55%. A Ki-67 < 55% and receiving adjuvant chemotherapy were statistically significant factors of improved OS after liver resection/RFA. Conclusion This study shows a long median and long term survival after liver surgery/RFA for these selected metastatic GEP-NEC patients, particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population. © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
Keywords: survival; adult; cancer survival; clinical article; aged; disease-free survival; middle aged; survival rate; overall survival; cancer recurrence; cisplatin; interferon; liver neoplasms; capecitabine; adjuvant therapy; cancer adjuvant therapy; disease free survival; chemotherapy, adjuvant; pancreatic neoplasms; temozolomide; antineoplastic agent; cancer grading; ki 67 antigen; ki-67 antigen; carboplatin; progression free survival; etoposide; antineoplastic combined chemotherapy protocols; cohort analysis; recurrence; pathology; pneumonia; postoperative complication; liver failure; liver metastasis; liver; adjuvant chemotherapy; pancreatitis; pancreas tumor; surgical infection; recurrent disease; surgery; liver resection; hepatectomy; pleura effusion; intestine obstruction; metastases; portal vein thrombosis; radiofrequency ablation; intestine tumor; intestinal neoplasms; stomach neoplasms; everolimus; catheter ablation; somatostatin derivative; stomach tumor; small intestine obstruction; neuroendocrine carcinoma; carcinoma, neuroendocrine; synaptophysin; adverse effects; chromogranin a; abscess; secondary; gastroenteropancreatic neuroendocrine tumor; neoplasm grading; humans; human; male; female; priority journal; article; artificial embolization
Journal Title: European Journal of Surgical Oncology
Volume: 43
Issue: 9
ISSN: 0748-7983
Publisher: Elsevier Inc.  
Date Published: 2017-09-01
Start Page: 1682
End Page: 1689
Language: English
DOI: 10.1016/j.ejso.2017.04.010
PUBMED: 28522174
PROVIDER: scopus
Notes: Article -- Export Date: 4 October 2017 -- Source: Scopus
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MSK Authors
  1. Laura Hong Tang
    356 Tang