Liver Transplantation for Neuroendocrine Tumors in Europe—Results and Trends in Patient Selection

Treut, Yves Patrice Le; Grégoire, Émilie; Klempnauer, Jürgen; Belghiti, Jacques; Jouve, Élisabeth; Lerut, Jan; Castaing, Denis; Soubrane, Olivier; Boillot, Olivier; Mantion, Georges; Homayounfar, Kia; Bustamante, M.; Azoulay, Daniel; Wolf, Philippe; Krawczyk, Marek; Pascher, Andreas; Suc, B.; Chiche, Laurence; Urbina, J. Ortiz de; Mejzlík, Vladimír; Pascual, Manuel; Lodge, J.P.A.; Gruttadauria, Salvatore; Paye, François; Pruvot, F.R.; Thorban, Stefan; Foss, Aksel; Adam, René

doi:10.1097/sla.0b013e31828ee17c

Cited by 219 publications

(259 citation statements)

References 25 publications

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“…The only prospective study recommended strict selection criteria for LT with curative intent (i.e., low grade, removal of primary tumor, liver involvement < 50%, age < 55 years, and stable disease for ≥ 6 mo before LT) [21] , and a study reported 96% overall survival and 80% disease-free survival [22] . However, it was also reported that P-NET patients with liver metastases who received LT had a follow-up term of no longer than 5.8 years, and the longest tumor-free survival was 5.1 years [23] , and a high rate of tumor recurrence was reported at almost 60% [20] . Use of LT for extended indications always presents an ethical dilemma [10] .…”

Section: Lt For Unresectable Liver Metastasesmentioning

confidence: 99%

“…Several attempts to implement this strategy between 1960 and the 1980s showed poor results, although LT for early hepatocellular carcinoma has been established [18] . It is well known that highly selected P-NET patients with liver metastases may be candidates for LT [10,[19][20][21] . The only prospective study recommended strict selection criteria for LT with curative intent (i.e., low grade, removal of primary tumor, liver involvement < 50%, age < 55 years, and stable disease for ≥ 6 mo before LT) [21] , and a study reported 96% overall survival and 80% disease-free survival [22] .…”

Section: Lt For Unresectable Liver Metastasesmentioning

confidence: 99%

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Pancreatic neuroendocrine tumor accompanied with multiple liver metastases

Hori¹,

Takaori²,

Üemoto³

2014

WJH

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Pancreatic neuroendocrine tumor (P-NET) is rare and slow-growing. Current classifications predict its prognosis and postoperative recurrence. Curative resection is ideal, although often difficult, because over 80% of patients have unresectable multiple liver metastases and extrahepatic metastasis. Aggressive surgery for liver metastases is important to improve survival. Aggressive or cytoreductive surgery for liver metastases is indicated to reduce hormone levels and improve symptoms and prognosis. Liver transplantation was originally conceived as an ideal therapy for unresectable liver metastases. Unfortunately, there is no clear consensus on the role and timing of surgery for primary tumor and liver metastases. Surgeons still face questions in deciding the best surgical scenario in patients with P-NET with unresectable liver metastases. Key words: Gastroenteropancreatic neuroendocrine tumor; Pancreas; Liver metastasis; Liver surgery; Liver transplantation Core tip: Pancreatic neuroendocrine tumor is rare. Current classifications predict its prognosis and postoperative recurrence. Curative resection is often difficult, because over 80% of patients have unresectable multiple liver metastases and extrahepatic metastasis. Aggressive or cytoreductive surgery for liver metastases is indicated to reduce hormone levels and improve symptoms and prognosis. Liver transplantation was originally conceived as an ideal therapy for unresectable liver metastases. However, there is no clear consensus on the role and timing of surgery for primary tumor and liver metastases.

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Section: Lt For Unresectable Liver Metastasesmentioning

confidence: 99%

Section: Lt For Unresectable Liver Metastasesmentioning

confidence: 99%

Pancreatic neuroendocrine tumor accompanied with multiple liver metastases

Hori¹,

Takaori²,

Üemoto³

2014

WJH

View full text Add to dashboard Cite

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“…[80][81][82][83][84] Recently, a European registry study described outcomes of 213 cases that underwent LT for metastatic NET, the largest number of patients to date; 5-y overall and disease-free survival rates were 52% and 30%, respectively. 85 Hepatomegaly, poor tumor differentiation, and major resection concurrent with LT were revealed to be poor prognostic indicators and better survival rates of nearly 60% were achieved in cases performed after 2000 because of more favorable patient characteristics. 85 There is a growing consensus that LT for metastatic NET should be considered for unresectable disease, no extrahepatic disease, welldifferentiated NET (NET G1/G2), and should not be associated with major extrahepatic resection.…”

Section: Metastatic Liver Tumors Neuroendocrine Tumor (Net)mentioning

confidence: 99%

“…85 Hepatomegaly, poor tumor differentiation, and major resection concurrent with LT were revealed to be poor prognostic indicators and better survival rates of nearly 60% were achieved in cases performed after 2000 because of more favorable patient characteristics. 85 There is a growing consensus that LT for metastatic NET should be considered for unresectable disease, no extrahepatic disease, welldifferentiated NET (NET G1/G2), and should not be associated with major extrahepatic resection. 85 Medical treatment continues to evolve and the timing of LT remains controversial.…”

Section: Metastatic Liver Tumors Neuroendocrine Tumor (Net)mentioning

confidence: 99%

“…85 There is a growing consensus that LT for metastatic NET should be considered for unresectable disease, no extrahepatic disease, welldifferentiated NET (NET G1/G2), and should not be associated with major extrahepatic resection. 85 Medical treatment continues to evolve and the timing of LT remains controversial. 85 …”

Section: Metastatic Liver Tumors Neuroendocrine Tumor (Net)mentioning

confidence: 99%

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Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine

et al. 2014

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Long-Term Survival, Prognostic Factors, and Selection of Patients With Colorectal Cancer for Liver Transplant

et al. 2023

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ImportanceLiver transplant for colorectal cancer with liver metastases was abandoned in the 1990s due to poor overall survival. From 2006, liver transplant for in nonresectable colorectal liver metastases has been reexamined through different prospective trials.ObjectiveTo determine predictive factors for transplant long-term survival and cure after liver transplant.Design, Setting, and ParticipantsThis was a prospective, nonrandomized controlled cohort study derived from different clinical trials on liver transplant for colorectal liver metastases from 2006 to 2020 at Oslo University Hospital. The trials differed in prognostic inclusion criteria, but the design was otherwise identical regarding follow-up scheme to determine disease recurrence, overall survival, and survival after relapse. Final data analysis was performed on December 31, 2021. All patients with colorectal liver metastases from comparable prospective liver transplant studies were included.ExposureLiver transplant.Main outcomes and measuresDisease-free survival, overall survival, and survival time after recurrence were determined in all participants.ResultsA total of 61 patients (median [range] age, 57.8 [28.7-71.1] years; 35 male [57.4%]) underwent liver transplant at Oslo University Hospital. Posttransplant observation time ranged from 16 to 165 months, and no patient was lost to follow-up. Median disease-free period, overall survival, and survival after relapse were 11.8 (95% CI, 9.3-14.2) months, 60.3 (95% CI, 44.3-76.4) months, and 37.1 (95% CI, 4.6-69.5) months, respectively. Negative predictive factors for overall survival included the following: largest tumor size greater than 5.5 cm (median OS, 25.3 months; 95% CI, 15.8-34.8 months; P &lt;.001), progressive disease while receiving chemotherapy (median OS, 39.8 months; 95% CI, 28.8-50.7 months; P = .02), plasma carcinoembryonic antigen values greater than 80 μg/L (median OS, 26.6 months; 95% CI, 22.7-30.6 months; P &lt;.001), liver metabolic tumor volume on positron emission tomography of greater than 70 cm3 (26.6 months; 95% CI, 11.8-41.5 months; P &lt;.001), primary tumor in the ascending colon (17.9 months; 95% CI, 0-37.5 months; P &lt;.001), tumor burden score of 9 or higher (23.3 months; 95% CI, 19.2-27.4 months; P = .02), and 9 or more liver lesions (42.5 months; 95% CI, 17.2-67.8 months; P = .02). An Oslo score of 0 or Fong Clinical Risk Score of 1 yielded 10-year survival of 88.9% and 80.0%, respectively.Conclusions and relevanceResults of this nonrandomized controlled trial suggest that selected patients with liver-only metastases and favorable pretransplant prognostic scoring had long-term survival comparable with conventional indications for liver transplant, thus providing a potential curative treatment option in patients otherwise offered only palliative care.

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Liver Transplantation for Neuroendocrine Tumors in Europe—Results and Trends in Patient Selection

Cited by 219 publications

References 25 publications

Pancreatic neuroendocrine tumor accompanied with multiple liver metastases

Pancreatic neuroendocrine tumor accompanied with multiple liver metastases

Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine

Long-Term Survival, Prognostic Factors, and Selection of Patients With Colorectal Cancer for Liver Transplant

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