A Novel Nomogram to Predict the Prognosis of Patients Undergoing Liver Resection for Neuroendocrine Liver Metastasis: an Analysis of the Italian Neuroendocrine Liver Metastasis Database

Abstract

Even though surgery remains the only potentially curative option for patients with neuroendocrine liver metastases, the factors determining a patient's prognosis following hepatectomy are poorly understood. Using a multicentric database including patients who underwent hepatectomy for NELMs at seven tertiary referral hepato-biliary-pancreatic centers between January 1990 and December 2014, we sought to identify the predictors of survival and develop a clinical tool to predict patient's prognosis after liver resection for NELMs. The median age of the 238 patients included in the study was 61.9 years (interquartile range 51.5-70.1) and 55.9 % (n = 133) of patients were men. The number of NELMs (hazard ratio = 1.05), tumor size (HR = 1.01), and Ki-67 index (HR = 1.07) were the predictors of overall survival. These variables were used to develop a nomogram able to predict survival. According to the predicted 5-year OS, patients were divided into three different risk classes: 19.3, 55.5, and 25.2 % of patients were in low (>80 % predicted 5-year OS), medium (40-80 % predicted 5-year OS), and high (<40 % predicted 5-year OS) risk classes. The 10-year OS was 97.0, 55.9, and 20.0 % in the low, medium, and high-risk classes, respectively (p < 0.001). We developed a novel nomogram that accurately (c-index >70 %) staged and predicted the prognosis of patients undergoing liver resection for NELMs.

Measurement of circulating transcript levels (NETest) to detect disease recurrence and improve follow‐up after curative surgical resection of well‐differentiated pancreatic neuroendocrine tumors

“…A key unmet need in improving outcome is the early detection of recurrent disease and the timely initiation of treatment after pNET resection. In many cases, early detection of recurrence offers more favorable treatment options, sometimes with curative intent, such as resection of the remnant pancreas or solitary liver metastases . Liver‐directed, locally ablative procedures are recommended for patients with limited, nonresectable tumor burden .…”

“…In many cases, early detection of recurrence offers more favorable treatment options, sometimes with curative intent, such as resection of the remnant pancreas or solitary liver metastases. 11,12 Liver-directed, locally ablative procedures are recommended for patients with limited, nonresectable tumor burden. [13][14][15] When recurrence is discovered with an extensive disseminated disease, systemic treatment is often the only option.…”

Management and outcomes of patients with recurrent neuroendocrine liver metastasis after curative surgery: An international multi‐institutional analysis

“…In fact, while the natural history of many GEP‐NET can be indolent, up to 60‐90% of patients develop liver metastasis during the course of their disease . The presence of neuroendocrine liver metastases (NELM) can adversely impact patient quality of life via hormone secretion, as well as be associated with worse long‐term outcomes . Specifically, the 5‐year overall survival (OS) of patients with NELM ranges from 13% to 54% versus 75% to 99% for patients with non‐metastatic NET .…”

“…2 The presence of neuroendocrine liver metastases (NELM) can adversely impact patient quality of life via hormone secretion, as well as be associated with worse long-term outcomes. 3 Specifically, the 5-year overall survival (OS) of patients with NELM ranges from 13% to 54% versus 75% to 99% for patients with non-metastatic NET. [4][5][6] As such, treatment of NELM plays a central role in the management of patients with NET.…”

Circulating tumor cells and miRNAs as prognostic markers in neuroendocrine neoplasms

“…However, as underlined by the ENETS guidelines, NEN prognosis may also depend on patient age, tumor site, metastatic spread and hormonal production. Several methods have been proposed to predict overall survival (OS) and progression-free survival (PFS) of NEN patients, including clinical nomograms taking into account the number of liver metastases, tumor size and Ki67 index (Ruzzenente et al 2016) or blood neutrophilto-lymphocyte ratio, Ki67 index and lymph node ratio (Cao et al 2016), positron emission tomography results by means of new tracers, such as (18)F-fluorothymidine (Johnbeck et al 2016), or molecular markers, such as HOPX promoter methylation/gene expression (Ushiku et al 2016) or phosphorylated histone H3 assessment (Villani et al 2016). Besides tissue-based characteristics, blood-based biomarkers have been considered, also due to easy accessibility of the compartment and possibility 24:6 of multiple sampling.…”