Prognostic factors influencing survival in small bowel neuroendocrine tumor with liver metastases

Manguso, Nicholas; Nissen, Nicholas N.; Hendifar, Andrew Eugene; Harit, Attiya; Mirocha, James; Friedman, Marc L.; Lipshutz, Herbert; Amersi, Farin

doi:10.1002/jso.25657

Cited by 11 publications

(10 citation statements)

References 25 publications

(65 reference statements)

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“…This may be explained by the extent of liver-disease at the time of surgery which is in the majority of patients more extended than documented by preoperative functional staging. The long term survival of the patients analyzed after 10-years is in concordance with literature [9].…”

Section: Discussionsupporting

confidence: 88%

“…A recent analysis showed that the type of liver resection (anatomic versus non-anatomic) in patients with M1 disease showed higher rates of recurrence after non-anatomic resection but the type of resection did not affect overall survival [8]. Another analysis of 111 patients found that surgical resection influenced mortality after 5 but not after 10 years [9]. It was the aim of this study to compare survival rates of patients with and without liver metastasis and to investigate whether surgery for hepatic metastasis can improve overall survival.…”

Section: Introductionmentioning

confidence: 99%

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Neuroendocrine liver metastasis from the small intestine: Is surgery beneficial for survival?

Selberherr

Freermann

Koperek

et al. 2021

Orphanet J Rare Dis

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Background Neuroendocrine neoplasia of the small intestine (siNEN) are frequently diagnosed with liver metastases. The impact of the presence of liver metastases on overall survival and the necessity of surgery for liver metastasis is discussed controversially. The aim of this study is to evaluate and compare the overall long-term survival of patients with siNENs with and without liver metastasis at initial diagnosis and the possible benefit of surgical treatment as compared to active surveillance of metastases. 123 consecutive patients with siNENs were treated between 1965 and 2016. All clinical and histological records were reevaluated including analysis of the proliferation rates in all specimens. The 1-, 5-, 10- and 20-year overall survival was estimated by Kaplan–Meier analysis for patients with and without liver metastasis and according to the type of treatment (surgical vs. surveillance) of liver metastases if present. Results The 1-, 5-, 10- and 20-year overall survival rate was 89.0%, 68.4%, 52.8% and 31.0% in patients without and 89.5%, 69.5%, 33.2% and 3.6% in those with liver metastases. No statistically significant differences were observed comparing the two groups. Within the group of patients with liver metastases, the type of treatment (surgical vs. surveillance) was in favor of patients undergoing surgery. Multivariate analysis showed that the presence of liver metastases upon diagnosis was an individual risk factor associated with worse survival. Conclusion The presence of liver metastasis at initial diagnosis does not have a statistically significant influence on survival. Surgery for hepatic metastasis seems to show a benefit for overall survival and may be indicated especially in patients symptomatic due to high tumor burden and serotonin hypersecretion to reduce hormone activity.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Neuroendocrine liver metastasis from the small intestine: Is surgery beneficial for survival?

Selberherr

Freermann

Koperek

et al. 2021

Orphanet J Rare Dis

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show abstract

“…A certain proportion of small bowel cancer patients presented with evidence of distant metastases at the initial diagnosis, wherein liver exhibited the most common metastatic organ [ 5 , 6 ]. Evidently, the presence of liver metastases served as an important predictor for worse prognosis of small bowel cancer [ 6 , 7 ], which may due to the increasing tumor burden and impairment of vital organ function caused by disease progression. Owing to the rarity of small bowel cancer with liver metastases, a population-based study regarding to the frequency as well as the prognosis for those population was still lacking.…”

Section: Introductionmentioning

confidence: 99%

Frequency, prognosis and treatment modalities of newly diagnosed small bowel cancer with liver metastases

Wang

Xing

et al. 2020

BMC Gastroenterol

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Background Population-based analysis for the liver metastases of small bowel cancer is currently lacking. This study aimed to analyze the frequency, prognosis and treatment modalities for newly diagnosed small bowel cancer patients with liver metastases. Methods Patients with small bowel cancer diagnosed from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Binary logistic regression analysis was performed to determine predictors for the presence of liver metastases at diagnosis. Kaplan–Meier method and Cox regression analyses were performed for survival analyses. Results A total of 1461 small bowel cancer patients with liver metastases at initial diagnosis were identified, representing 16.5% of the entire set and 63.9% of the subset with metastatic disease to any distant site. Primary tumor with poorer histological type, larger tumor size, later N staging, more extrahepatic metastatic sites, and tumor on lower part of small intestine had increased propensity of developing liver metastases. The combined diagnostic model exhibited acceptable diagnostic efficiency with AUC value equal to 0.749. Patients with liver metastases had significant poorer survival (P < 0.001) than those without liver metastases. In addition, combination of surgery and chemotherapy (HR = 0.27, P < 0.001) conferred the optimal survival for patients with adenocarcinoma, while the optimal treatment options for NEC and GIST seemed to be surgery alone (HR = 0.24, P < 0.001) and chemotherapy alone (HR = 0.08, P = 0.022), respectively. Conclusions The combined predictor had a good ability to predict the presence of liver metastases. In addition, those patients with different histologic types should be treated with distinct therapeutic strategy for obtaining optimal survival.

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“…Factors influencing prognosis are unclear. Manguso et al [ 74 •] recently evaluated how the extent of liver resection (complete resection ([CR], partial resection [PR], or no resection [NR]) influences outcomes after complete resection of the primary tumour.…”

Section: Functionalitymentioning

confidence: 99%

How to Manage Small Intestine (Jejunal and Ileal) Neuroendocrine Neoplasms Presenting with Liver Metastases?

2021

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Purpose of Review Small intestinal neuroendocrine neoplasms (siNENs) are slowly growing tumours with a low malignant potential. However, more than half of the patients present with distant metastases (stage IV) and nearly all with locoregional lymph node (LN) metastases at the time of surgery. The value of locoregional treatment is discussed controversially. Recent Findings In stage I to III disease, locoregional surgery was currently shown to be curative prolonging survival. In stage IV disease, surgery may prolong survival in selected patients with the chance to cure locoregional disease besides radical/debulking liver surgery. It may improve the quality of life and may prevent severe local complications resulting in a state of chronic malnutrition and severe intestinal ischaemia or bowel obstruction. Summary Locoregional tumour resection offers the opportunity to be curative or to focus therapeutically on liver metastasis, facilitating various other therapeutic modalities. Risks and benefits of the surgical intervention need to be balanced individually.

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Prognostic factors influencing survival in small bowel neuroendocrine tumor with liver metastases

Cited by 11 publications

References 25 publications

Neuroendocrine liver metastasis from the small intestine: Is surgery beneficial for survival?

Neuroendocrine liver metastasis from the small intestine: Is surgery beneficial for survival?

Frequency, prognosis and treatment modalities of newly diagnosed small bowel cancer with liver metastases

How to Manage Small Intestine (Jejunal and Ileal) Neuroendocrine Neoplasms Presenting with Liver Metastases?

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