title: Small intestinal neuroendocrine tumors with liver metastases and resection of the primary: Prognostic factors for decision making.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Hepatobiliopancreatic Surgery, European Institute of Oncology, University of Milano, Italy. Electronic address: emilio.bertani@ieo.it.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bertani
authors.affiliation: Division of Pancreatic Surgery, Ospedale San Raffaele IRCCS, Università Vita e Salute, Milano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.affiliation: Division of Nuclear Medicine, European Institute of Oncology, Milano, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Grana
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milano, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Botteri
authors.affiliation: Division of Digestive Surgery, European Institute of Oncology, Milano, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiappa
authors.affiliation: Division of General Surgery, Cantù Hospital, Cantù, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Misitano
authors.affiliation: Gastrointestinal and Neuroendocrine Cancer Medical Treatment Unit, European Institute of Oncology, Milano, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Spada
authors.affiliation: Division of Endoscopy, European Institute of Oncology, Milano, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Ravizza
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milano, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bazolli
authors.affiliation: Gastrointestinal and Neuroendocrine Cancer Medical Treatment Unit, European Institute of Oncology, Milano, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fazio
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D065426:Cytoreduction Surgical Procedures / Q000379:methods / Q000401:mortality; D003657:Decision Making; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D047368:Tumor Burden
keywords: Liver metastases; Liver resection; Small intestine neuroendocrine tumors; Survival