Neuroendocrine liver metastasis: The chance to be cured after liver surgery.
OBJECTIVE
Neuroendocrine liver metastasis tumors (NELM) are a heterogeneous group of neoplasms with varied histologic features and a wide range of clinical behaviors. We aimed to identify the fraction of patients cured after liver surgery for NELM.


METHODS
Cure fraction models were used to analyze 376 patients who underwent hepatectomy with curative intent for NELM.


RESULTS
The median and 5-year disease-free survival (DFS) were 4.5 years and 46%, respectively. The probability of being cured from NELM by liver surgery was 44%; the time to cure was 5.1 years. In a multivariable cure model, type of neuroendocrine tumor (NET), grade of tumor differentiation, and rate of liver involvement resulted as independent predictors of cure. The cure fraction for patients with well differentiated NELM from gastrointestinal NET or a functional pancreatic NET, and with <50% of liver-involvement was 95%. Patients who had moderately/poorly differentiated NELM from a non-functional pancreatic NET, and with <50% of liver-involvement was 43%. In the presence of all the three unfavorable prognostic factors (nonfunctional PNET, liver involvement >50%, moderately/poorly differentiation), the cure fraction was 8%.


CONCLUSIONS
Statistical cure after surgery for NELM is possible, and allow for a more accurate prediction of long-term outcome among patients with NELM undergoing liver resection.
Department of Surgery, University of Verona, Verona, Italy.
Fabio
F
Bagante
Department of Surgery, University of Verona, Verona, Italy.
Gaya
G
Spolverato
Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
Katiuscha
K
Merath
Department of Surgery, Emory University, Atlanta, Georgia.
Lauren McLendon
LM
Postlewait
Department of Surgery, School of Medicine, Stanford University, Stanford, California.
George A
GA
Poultsides
Department of Surgery, University of Virginia, Charlottesville, Virginia.
Matthew G
MG
Mullen
Department of Surgery, University of Virginia, Charlottesville, Virginia.
Todd W
TW
Bauer
Department of Surgery, School of Medicine, Washington University, St Louis, Missouri.
Ryan C
RC
Fields
Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
Jorge
J
Lamelas
Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
Hugo P
HP
Marques
Department of Surgery, Liver Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
Luca
L
Aldrighetti
Department of Surgery, School of Medicine, Stanford University, Stanford, California.
Thuy
T
Tran
Department of Surgery, Emory University, Atlanta, Georgia.
Shishir K
SK
Maithel
Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
Timothy M
TM
Pawlik
D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
cure model; liver surgery; neuroendocrine liver metastasis