Emilio Bertani1, Massimo Falconi2, Chiara Grana3, Edoardo Botteri4, Antonio Chiappa5, Pasquale Misitano6, Francesca Spada7, Davide Ravizza8, Barbara Bazolli4, Nicola Fazio7. 1. Division of Hepatobiliopancreatic Surgery, European Institute of Oncology, University of Milano, Italy. Electronic address: emilio.bertani@ieo.it. 2. Division of Pancreatic Surgery, Ospedale San Raffaele IRCCS, Università Vita e Salute, Milano, Italy. 3. Division of Nuclear Medicine, European Institute of Oncology, Milano, Italy. 4. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milano, Italy. 5. Division of Digestive Surgery, European Institute of Oncology, Milano, Italy. 6. Division of General Surgery, Cantù Hospital, Cantù, Italy. 7. Gastrointestinal and Neuroendocrine Cancer Medical Treatment Unit, European Institute of Oncology, Milano, Italy. 8. Division of Endoscopy, European Institute of Oncology, Milano, Italy.
Abstract
INTRODUCTION: Patients with small intestine neuroendocrine tumors present with liver metastases in 50-75% of cases at diagnosis. The aim of the present study was to assess prognostic factors in patients with liver metastases from intestinal neuroendocrine tumor after primary tumor surgical removal with or without liver surgery or radiofrequency ablation. The primary endpoint was disease-specific survival. METHODS: Data regarding seventy-eight consecutive patients with liver metastases who undergone primary tumor surgical removal between 1996 and 2011 were extracted from the institutional tumor registry and retrospectively analyzed. RESULTS: Liver tumor burden was <25% in 43 (55.1%) 25-50% in 30 (38.5%) and >50% in 5 (6.4%) patients. For the whole cohort of patients disease-specific survival at 3, 5 and 8 years was 93.2%, 83.6% and 77.3%, respectively. Fifteen patients who underwent radical liver surgery were all alive with a median survival of 106 months (range 18-152 months). In multivariate analysis the Ki-67 index in a continuous fashion significantly correlate with prognosis (p = 0.021). Liver tumor burden (p = 0.036) and extrahepatic involvement (p = 0.03), were the most powerful prognosticators for patients who underwent only debulking surgery. CONCLUSION: The Ki-67 index, the liver tumor burden and the presence of extrahepatic metastases should be carefully considered in the selection criteria for liver debulking in asymptomatic patients.
INTRODUCTION:Patients with small intestine neuroendocrine tumors present with liver metastases in 50-75% of cases at diagnosis. The aim of the present study was to assess prognostic factors in patients with liver metastases from intestinal neuroendocrine tumor after primary tumor surgical removal with or without liver surgery or radiofrequency ablation. The primary endpoint was disease-specific survival. METHODS: Data regarding seventy-eight consecutive patients with liver metastases who undergone primary tumor surgical removal between 1996 and 2011 were extracted from the institutional tumor registry and retrospectively analyzed. RESULTS:Liver tumor burden was <25% in 43 (55.1%) 25-50% in 30 (38.5%) and >50% in 5 (6.4%) patients. For the whole cohort of patients disease-specific survival at 3, 5 and 8 years was 93.2%, 83.6% and 77.3%, respectively. Fifteen patients who underwent radical liver surgery were all alive with a median survival of 106 months (range 18-152 months). In multivariate analysis the Ki-67 index in a continuous fashion significantly correlate with prognosis (p = 0.021). Liver tumor burden (p = 0.036) and extrahepatic involvement (p = 0.03), were the most powerful prognosticators for patients who underwent only debulking surgery. CONCLUSION: The Ki-67 index, the liver tumor burden and the presence of extrahepatic metastases should be carefully considered in the selection criteria for liver debulking in asymptomatic patients.
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