Liver resection for liver metastases from nondigestive endocrine cancer: extrahepatic disease burden defines outcome.
BACKGROUND
For patients with hepatic nondigestive endocrine metastases (HNEM), the role of liver resection is not well-defined.


METHODS
We reviewed outcomes for patients who underwent liver resection for HNEM at 2 centers to identify predictors of survival.


RESULTS
From 1991 to 2010, 51 patients underwent liver resection for HNEM. Primary tumor types were adrenal gland (n = 26), thyroid (n = 11), testicular germ cell (n = 9), and ovarian granulosa cell (n = 5). 28 patients (55%) had synchronous or early (diagnosed within 12 months after primary tumor resection) liver metastases. At liver resection, 26 patients (51%) had extrahepatic metastases, and 7 (14%) had ≥2 sites of extrahepatic metastases. 32 patients (63%) had major liver resection and 19 (37%) had a simultaneous extrahepatic procedure. 90-day postoperative morbidity and mortality rates were 27% and 2%, respectively. After median follow-up of 20 months (range, 1-144), the 5-year overall and recurrence-free survival rates were 58% and 37%, respectively. Survival was not affected by primary tumor type. In multivariate analysis, ≥2 sites of extrahepatic metastases (hazard ratio [HR] = 4.80; 95% confidence interval [CI] = 1.18-19.50; P = .028) and interval of ≤12 months between primary tumor resection and diagnosis of liver metastases (HR = 5.33; 95% CI = 1.11-25.71; P = .037) were associated with worse overall survival after liver resection.


CONCLUSIONS
For selected patients, liver resection for HNEM is associated with long-term survival. The number of extrahepatic sites of metastasis and the timing of appearance of liver metastases should be considered in patient selection.
Department of Surgical Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
Andreas
A
Andreou
Antoine
A
Brouquet
Kishore G S
KG
Bharathy
Nancy D
ND
Perrier
Eddie K
EK
Abdalla
Steven A
SA
Curley
Matthias
M
Glanemann
Daniel
D
Seehofer
Peter
P
Neuhaus
Jean-Nicolas
JN
Vauthey
Thomas A
TA
Aloia
D000310:Adrenal Gland Neoplasms / Q000473:pathology*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000473:pathology*; D016896:Treatment Outcome