Andreas Selberherr1, Simon Freermann2, Oskar Koperek3, Martin B Niederle4, Philipp Riss2, Christian Scheuba2, Bruno Niederle2. 1. Section "Endocrine Surgery", Division of General Surgery, Department of Surgery, Medical University, Währinger Gürtel 18-20, 1090, Vienna, Austria. andreas.selberherr@meduniwien.ac.at. 2. Section "Endocrine Surgery", Division of General Surgery, Department of Surgery, Medical University, Währinger Gürtel 18-20, 1090, Vienna, Austria. 3. Department of Pathology, Medical University, Währinger Gürtel 18-20, 1090, Vienna, Austria. 4. Department of Anesthesiology, Medical University, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Abstract
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.
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.
Entities:
Keywords:
Livermetastasis; NEN; NET; Neuroendocrine neoplasia; Neuroendocrine tumors; Small intestine
Authors: Marianne Pavel; Eric Baudin; Anne Couvelard; Eric Krenning; Kjell Öberg; Thomas Steinmüller; Martin Anlauf; Bertram Wiedenmann; Ramon Salazar Journal: Neuroendocrinology Date: 2012-02-15 Impact factor: 4.914
Authors: U Knigge; J Capdevila; D K Bartsch; E Baudin; J Falkerby; R Kianmanesh; B Kos-Kudla; B Niederle; E Nieveen van Dijkum; D O'Toole; A Pascher; N Reed; A Sundin; M-P Vullierme Journal: Neuroendocrinology Date: 2017-02-17 Impact factor: 4.914
Authors: Demetrios Moris; Ioannis Ntanasis-Stathopoulos; Diamantis I Tsilimigras; Stylianos Vagios; Andreas Karamitros; Georgios Karaolanis; John Griniatsos; Alexandros Papalampros; Ioannis Papaconstantinou; Georgios K Glantzounis; Eleftherios Spartalis; Dan G Blazer; Evangelos Felekouras Journal: Anticancer Res Date: 2018-03 Impact factor: 2.480
Authors: Matias Riihimäki; Akseli Hemminki; Kristina Sundquist; Jan Sundquist; Kari Hemminki Journal: Int J Cancer Date: 2016-09-09 Impact factor: 7.396
Authors: James C Yao; Manal Hassan; Alexandria Phan; Cecile Dagohoy; Colleen Leary; Jeannette E Mares; Eddie K Abdalla; Jason B Fleming; Jean-Nicolas Vauthey; Asif Rashid; Douglas B Evans Journal: J Clin Oncol Date: 2008-06-20 Impact factor: 44.544
Authors: Martyn E Caplin; Marianne Pavel; Jarosław B Ćwikła; Alexandria T Phan; Markus Raderer; Eva Sedláčková; Guillaume Cadiot; Edward M Wolin; Jaume Capdevila; Lucy Wall; Guido Rindi; Alison Langley; Séverine Martinez; Edda Gomez-Panzani; Philippe Ruszniewski Journal: Endocr Relat Cancer Date: 2016-01-07 Impact factor: 5.678