title: Liver transplantation for hepatic metastases of neuroendocrine pancreatic tumors: a survival-based analysis.
abstract: BACKGROUND
  Liver transplantation (LT) has been accepted as a treatment in selected cases of neuroendocrine tumors (NETs) with hepatic metastases.
  
  
  METHODS
  A systematic review of the literature was conducted to evaluate long-term patient survival in the instances of LT for pancreatic NET. Univariate and multivariate regression analyses and survival analysis were performed.
  
  
  RESULTS
  Fifty-three clinical studies were screened. Data from 20 studies encompassing 89 transplanted patients were included in the study. Most primary tumors were endocrine pancreatic tumors (n=69), with gastrinomas representing the most frequent diagnosis (n=21). There were 61 functioning pancreatic NET. Simultaneous LT and pancreatic NET resections were performed in 45 instances. Cumulative 1-, 3-, and 5-year survival was 71%, 55%, and 44%, respectively, with a calculated mean survival of 54.45±6.31 months. Vasoactive intestinal peptide (VIPomas) had the best overall survival. Recurrence-free survival at 1, 3, and 5 years was 84%, 47%, and 47%, respectively. Recipient age more than or equal to 55 years (P=0.0242) and simultaneous LT-pancreatic resection (P=0.0132) were found to be significant predictors of worse survival by both univariate and multivariate Cox proportional hazard analyses. A scoring system was developed, with prognostic points assigned as follows: age more than or equal to 55 years:age less than 55 years=1:0 points and simultaneous LT-pancreatic resection:LT alone=1:0 points. This stratification delineated three separate population samples corresponding to patients with scores of 0, 1, and 2, respectively. The calculated 5-year survival for scores 0, 1, and 2 was 61%, 40%, and 0%, respectively (P=0.0023).
  
  
  CONCLUSIONS
  Despite the limitations of this retrospective analysis, good results can be achieved even for pancreatic NET primaries if the above-proposed scoring system is applied.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstrasse 55, Essen, Germany.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Máthé
authors.forename: Evangelos
authors.initials: E
authors.lastname: Tagkalos
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: László
authors.initials: L
authors.lastname: Kóbori
authors.forename: Ioannis
authors.initials: I
authors.lastname: Fouzas
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D018278:Carcinoma, Neuroendocrine / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult