title: The Long-Term Benefit of Liver Transplantation for Hepatic Metastases From Neuroendocrine Tumors.
abstract: Selection criteria and benefit of liver transplantation for hepatic metastases from neuroendocrine tumors (NETs) remain uncertain. Eighty-eight consecutive patients with metastatic NETs eligible for liver transplantation according to Milan-NET criteria were offered transplant (n = 42) versus nontransplant options (n = 46) depending on list dynamics, patient disposition, and age. Tumor burden between groups did not differ. Transplant patients were younger (40.5 vs. 55.5 years; p < 0.001). Long-term outcomes were compared after matching between groups made on multiple Cox models adjusted for propensity score built on logistic models. Survival benefit was the difference in mean survival between transplant versus nontransplant options. No patients were lost or died without recurrence. Median follow-up was 122 months. The transplant group showed a significant advantage over nontransplant strategies at 5 and 10 years in survival (97.2% and 88.8% vs. 50.9% and 22.4%, respectively; p < 0.001) and time-to-progression (13.1% and 13.1% vs. 83.5% and 89%; p < 0.001). After adjustment for propensity score, survival advantage of the transplant group was significant (hazard ratio = 7.4; 95% confidence interval (CI): 2.4-23.0; p = 0.001). Adjusted transplant-related survival benefit was 6.82 months (95% CI: 1.10-12.54; p = 0.019) and 38.43 months (95% CI: 21.41-55.45; p < 0.001) at 5 and 10 years, respectively. Liver transplantation for metastatic NETs under restrictive criteria provides excellent long-term outcome. Transplant-related survival benefit increases over time and maximizes after 10 years.
authors.affiliation: Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Mazzaferro
authors.affiliation: Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Sposito
authors.affiliation: Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
authors.forename: J
authors.initials: J
authors.lastname: Coppa
authors.affiliation: Trial Office and Biomedical Statistics, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Miceli
authors.affiliation: Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bhoori
authors.affiliation: Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bongini
authors.affiliation: Trial Office and Biomedical Statistics, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Camerini
authors.affiliation: Pathology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Milione
authors.affiliation: Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Regalia
authors.affiliation: Interventional Radiology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Spreafico
authors.affiliation: Psychology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Gangeri
authors.affiliation: Medical Oncology Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Buzzoni
authors.affiliation: Medical Oncology Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy.
authors.forename: F G
authors.initials: FG
authors.lastname: de Braud
authors.affiliation: North Italian Transplant Procurement Agency, Organ and Tissue Transplant Immunology, IRCCS Policlinico Hospital, Milan, Italy.
authors.forename: T
authors.initials: T
authors.lastname: De Feo
authors.affiliation: Trial Office and Biomedical Statistics, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Mariani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology* / Q000601:surgery; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: cancer/malignancy/neoplasia; cancer/malignancy/neoplasia: metastatic disease; clinical research/practice; liver disease: malignant; liver transplantation/hepatology; recipient selection