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

Spolverato, Gaya; Bagante, Fabio; Aldrighetti, Luca; Poultsides, George A.; Bauer, Todd W.; Fields, Ryan C.; Maithel, Shishir K.; Weiss, Matthew J.; Pawlik, Timothy M.

doi:10.1002/jso.24670

Cited by 40 publications

(43 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, receipt of systemic chemotherapy was not associated with early recurrence on multivariate analysis. Rather, consist with previous studies, 6,7,30,31 primary NET characteristics including pancreatic NET, primary NET nodal metastasis, and the presence of extrahepatic disease at NELM diagnosis were independently associated with early recurrence. For patients with early intrahepatic-only recurrence, R1 resection was also an important risk factor.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Early Recurrence of Neuroendocrine Liver Metastasis After Curative Hepatectomy: Risk Factors, Prognosis, and Treatment

Zhang

Beal

Chakedis

et al. 2017

Journal of Gastrointestinal Surgery

Self Cite

View full text Add to dashboard Cite

Background Early tumor recurrence after curative resection typically indicates a poor prognosis. The objective of the current study was to investigate the risk factors, treatment, and prognosis of early recurrence of neuroendocrine tumor (NET) liver metastasis (NELM) after hepatic resection. Methods A total of 481 patients who underwent curative-intent resection for NELM were identified from a multiinstitutional database. Data on clinicopathological characteristics, intraoperative details, and outcomes were documented. The optimal cutoff value to differentiate early and late recurrence was determined to be 3 years based on linear regression. Results With a median follow-up of 60 months, 223 (46.4%) patients developed a recurrence, including 158 (70.9%) early and 65 (29.1%) late recurrences. On multivariable analysis, pancreatic NET, primary tumor lymph node metastasis, and a microscopic positive surgical margin were independent risk factors for early intrahepatic recurrence. While recurrence patterns and treatments were comparable among patients with early and late recurrences, early recurrence was associated with worse diseasespecific survival than late recurrences (10-year NELM-specific survival, 44.5 vs 75.8%, p < 0.001). Among the 34 (21.5%) patients who underwent curative treatment for early recurrence, post-recurrence disease-specific survival was better than noncuratively treated patients (10-year NELM-specific survival, 54.2 vs 26.3%, p = 0.028), yet similar to patients with late recurrences treated with curative intent (10-year NELM-specific survival, 54.2 vs 37.4%, p = 0.519). Conclusions Early recurrence after surgery for NELM was associated with the pancreatic type, primary lymph node metastasis, and extrahepatic disease. Re-treatment with curative intent prolonged survival after recurrence, and therefore, operative intervention even for early recurrences of NELM should be considered.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Intrahepatic recurrence following initial curative hepatectomy for NELM can be as high as 70-94% at 5 years. [6][7][8][9] Therefore, appropriate management of recurrence is central to improve prognosis of patients after NELM resection.…”

Section: Introductionmentioning

confidence: 99%

Early Recurrence of Neuroendocrine Liver Metastasis After Curative Hepatectomy: Risk Factors, Prognosis, and Treatment

Zhang

Beal

Chakedis

et al. 2017

Journal of Gastrointestinal Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Neuroendocrine tumors (NET) are a heterogeneous group of rare neoplasms mainly arising from the gastroenteropancreatic and bronchopulmonary systems . Although the natural history of NET is often considered to be indolent, up to 45% to 90% of patients can develop synchronous or metachronous neuroendocrine liver metastasis (NELM) during the course of the disease . Some patients with NELM will develop constitutional symptoms secondary to the hepatic disease burden, decreasing both quality of life and long‐term prognosis .…”

Section: Introductionmentioning

confidence: 99%

“…Many patients experience recurrence after curative‐intent resection. In fact, intrahepatic recurrence following initial curative‐intent hepatectomy for NELM can be as high as 70% to 95% at 5 years . Tumor differentiation has been identified as one of the strongest prognostic factors associated with NET prognosis .…”

Section: Introductionmentioning

confidence: 99%

“…1 Although the natural history of NET is often considered to be indolent, up to 45% to 90% of patients can develop synchronous or metachronous neuroendocrine liver metastasis (NELM) during the course of the disease. [2][3][4] Some patients with NELM will develop constitutional symptoms secondary to the hepatic disease burden, decreasing both quality of life and long-term prognosis. 5 Surgical management of NELM remains the only potential curative option and provides a 5-year survival benefit ranging from 60% to 85% in appropriately selected patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early recurrence of well‐differentiated (G1) neuroendocrine liver metastasis after curative‐intent surgery: Risk factors and outcome

Xiang

Zhang

Weiss

et al. 2018

Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

Background The objective of the current study was to identify the risk of early vs late recurrence of well‐differentiated (G1) neuroendocrine liver metastasis (NELM) after curative‐intent resection. Methods Patients who underwent curative‐intent resection for well‐differentiated NELM were identified from a multi‐institutional database. Clinicopathological details, as well as the long‐term overall (OS) and recurrence free survival (RFS) were obtained and compared. The optimal cutoff value to differentiate early and late recurrence was determined to be 1 year based on trend curve analysis. Results Among the 548 patients undergoing curative resection for NELM, 162 patients had a well‐differentiated NELM. After a median follow‐up of 69 months, 59 (36.4%) patients had tumor recurrence; 23 (39.0%) patients recurred within 1 year (early recurrence) after surgery, while 36 (61.0%) recurred after 1 year (late recurrence). Early recurrence was associated with worse outcome vs late recurrence (5‐year OS, 72.4% vs 92.0%; P = 0.020) and no recurrence (5‐year OS, 72.4% vs 100.0%; P < 0.001). In addition, postrecurrence survival was worse within 36 months after recurrence among patients who recurred early compared with patients who recurred late (survival after recurrence at 36 months: early recurrence, 71.6% vs late recurrence, 91.4%; P = 0.047), although survival was comparable at 60 months (early recurrence, 71.6% vs late recurrence, 70.0%; P = 0.304). On multivariable analysis, nonfunctional neuroendocrine tumors (hazard ratio [HR], 4.4; 95% confidence interval [CI], 1.2‐16.7; P = 0.029) and lymph node metastasis (HR, 3.6; 95% CI, 1.1‐11.1; P = 0.028) were independent risk factors for early recurrence, whereas lymph node metastasis (HR, 3.0; 95% CI, 1.2‐7.8; P = 0.020) and R1 resection (HR, 3.9; 95% CI, 1.4‐10.5; P = 0.008) were independently associated with late recurrence. Conclusions Roughly, one‐third of patients with well‐differentiated NELM experienced a recurrence following curative‐intent surgery. Among patients who recurred, two out of five patients recurred within 1 year after surgery. Early recurrence of well‐differentiated NELM was associated with the hormone functional status and lymph node metastasis.

show abstract

Survey of surgical resections for neuroendocrine liver metastases: A project study of the Japan Neuroendocrine Tumor Society (JNETS)

Aoki

Kubota

Kiritani

et al. 2021

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

Background/Purpose Hepatic resection is considered the treatment of choice for neuroendocrine liver metastases (NELM). However, the safety and efficacy of resection have not been fully evaluated using a large cohort. The aim of the present study was to collect real‐world data regarding hepatic resections for NELM. Methods A retrospective, multicenter survey was conducted. The background characteristics of patients undergoing an initial hepatic resection for NELM, the operative details, pathological findings, and patient outcomes were investigated. Results A total of 222 patients were enrolled from 30 institutions. The primary tumor site was the pancreas in 58.6%, and the presentation of NELM was synchronous in 63.1% of the cases. Concomitant resection of the primary tumor and liver metastases was performed for 66.4% of the synchronous metastases, and the 90‐day morbidity and mortality rates were 12.6% and 0.9%, respectively. The operations resulted in R2 resections in 26.1% of the cases, and 83.4% of the patients experienced recurrence after R0/1 resections. However, the patients were treated using multiple modalities after R2 resection or recurrence, and the overall survival rate was relatively favorable, with 5‐year and 10‐year survival rates of 70.2%, and 43.4%, respectively. Univariable and multivariable analyses identified the tumor grading (G3) of the primary tumor as a significant prognostic factor for both the recurrence‐free and overall survivals. Conclusions The present data confirmed the safety of the surgical resection of NELM. Although recurrences were frequent, the survival outcomes after resection were favorable when a multi‐disciplinary treatment approach was used.

show abstract

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

Abstract: Recurrence after surgery for NELM occurred among half of patients. Repeat liver resection for recurrence may offer a reasonable 5-year survival benefit.

Cited by 40 publications

References 30 publications

Early Recurrence of Neuroendocrine Liver Metastasis After Curative Hepatectomy: Risk Factors, Prognosis, and Treatment

Early Recurrence of Neuroendocrine Liver Metastasis After Curative Hepatectomy: Risk Factors, Prognosis, and Treatment

Early recurrence of well‐differentiated (G1) neuroendocrine liver metastasis after curative‐intent surgery: Risk factors and outcome

Survey of surgical resections for neuroendocrine liver metastases: A project study of the Japan Neuroendocrine Tumor Society (JNETS)

Contact Info

Product

Resources

About