title: Management of Neuroendocrine Tumor Liver Metastases: Long-Term Outcomes and Prognostic Factors from a Large Prospective Database.
abstract: BACKGROUND
  Liver-directed therapies have been used to treat neuroendocrine liver metastases (NELM) for both symptomatic improvement and tumor growth control. We reviewed our experience with NELM to investigate the outcomes of available treatment modalities and to identify prognostic factors for survival.
  
  
  METHODS
  We identified all patients with NELM, who were managed at our institution, from a prospectively collected institutional database. Overall survival (OS) was determined for each treatment modality.
  
  
  RESULTS
  Between 2003 and 2010, we identified 939 patients with neuroendocrine tumors, of whom 649 patients had NELM. The primary tumor site was the small intestine in 245 patients (38%) and pancreas in 194 patients (30%). With a median follow-up of 44 months, the median, 5 and 10 year OS for each treatment group was as follows: hepatic resection (n = 58, 9%), 160 months, 90%, 70%; radiofrequency ablation (n = 28, 4%), 123 months, 84%, 55%; chemoembolization (n = 130, 20%), 66 months, 55%, 28%; systemic therapy (n = 316, 49%), 70 months, 58%, 31%; and observation (n = 117, 18%), 38 months, 38%, 20%. Age [hazard ratio (HR) 1.0, p < 0.001), small bowel primary site (HR 0.5, p < 0.001), hepatic resection (HR 0.3, p = 0.001), well-differentiated tumors (HR 0.3, p < 0.001), alkaline phosphatase within normal limit (WNL) (HR 0.4, p < 0.001), and chromogranin A WNL (HR 0.5, p < 0.001) were significant independent prognosticators for OS.
  
  
  CONCLUSIONS
  This series represents one of the largest single-institution studies of NELM reported. We found that hepatic resection was associated with highly favorable OS. Our observations support hepatic resection in appropriately selected patients.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Fairweather
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Swanson
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Jiping
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Medical Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Brais
authors.affiliation: Department of Medical Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Trevor
authors.initials: T
authors.lastname: Dutton
authors.affiliation: Department of Medical Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Kulke
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA. tclancy@partners.org.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Clancy
mesh_terms: D017115:Catheter Ablation / Q000401:mortality*; D003131:Combined Modality Therapy / Q000401:mortality*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate