Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas

TY - JOUR

T1 - Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas

AU - Galleberg, R B

AU - Knigge, U

AU - Tiensuu Janson, E

AU - Vestermark, L W

AU - Haugvik, S-P

AU - Ladekarl, M

AU - Langer, S W

AU - Grønbæk, H

AU - Österlund, P

AU - Hjortland, G O

AU - Assmus, J

AU - Tang, L

AU - Perren, A

AU - Sorbye, H

N1 - Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

PY - 2017/9

Y1 - 2017/9

N2 - Background Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce. The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC. Methods 32 patients with a diagnosis of high-grade gastroenteropancreatic neuroendocrine neoplasm (Ki-67 > 20%) and with intended curative resection/RFA of liver metastases, were identified among 840 patients from two Nordic GEP-NEC registries. Tumor morphology (well vs poor differentiation) was reassessed. Overall survival (OS) and progression-free survival (PFS) was assessed by Kaplan–Meier analyses for the entire cohort and for subgroups. Results Median OS after resection/RFA of liver metastases was 35.9 months (95%-CI: 20.6–51.3) with a five-year OS of 43%. The median PFS was 8.4 months (95%-CI: 3.9–13). Four patients (13%) were disease-free after 5 years. Two patients had well-differentiated morphology (NET G3) and 20 patients (63%) had Ki-67 ≥ 55%. A Ki-67 < 55% and receiving adjuvant chemotherapy were statistically significant factors of improved OS after liver resection/RFA. Conclusion This study shows a long median and long term survival after liver surgery/RFA for these selected metastatic GEP-NEC patients, particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population.

AB - Background Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce. The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC. Methods 32 patients with a diagnosis of high-grade gastroenteropancreatic neuroendocrine neoplasm (Ki-67 > 20%) and with intended curative resection/RFA of liver metastases, were identified among 840 patients from two Nordic GEP-NEC registries. Tumor morphology (well vs poor differentiation) was reassessed. Overall survival (OS) and progression-free survival (PFS) was assessed by Kaplan–Meier analyses for the entire cohort and for subgroups. Results Median OS after resection/RFA of liver metastases was 35.9 months (95%-CI: 20.6–51.3) with a five-year OS of 43%. The median PFS was 8.4 months (95%-CI: 3.9–13). Four patients (13%) were disease-free after 5 years. Two patients had well-differentiated morphology (NET G3) and 20 patients (63%) had Ki-67 ≥ 55%. A Ki-67 < 55% and receiving adjuvant chemotherapy were statistically significant factors of improved OS after liver resection/RFA. Conclusion This study shows a long median and long term survival after liver surgery/RFA for these selected metastatic GEP-NEC patients, particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population.

KW - Adult

KW - Aged

KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use

KW - Carcinoma, Neuroendocrine/drug therapy

KW - Catheter Ablation/adverse effects

KW - Chemotherapy, Adjuvant

KW - Disease-Free Survival

KW - Female

KW - Hepatectomy/adverse effects

KW - Humans

KW - Intestinal Neoplasms/pathology

KW - Ki-67 Antigen/analysis

KW - Liver Neoplasms/drug therapy

KW - Male

KW - Middle Aged

KW - Neoplasm Grading

KW - Pancreatic Neoplasms/pathology

KW - Recurrence

KW - Stomach Neoplasms/pathology

KW - Survival Rate

U2 - 10.1016/j.ejso.2017.04.010

DO - 10.1016/j.ejso.2017.04.010

M3 - Journal article

C2 - 28522174

SN - 0748-7983

VL - 43

SP - 1682

EP - 1689

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 9

ER -