Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas

R. B. Galleberg*, U Knigge, E. Tiensuu Janson, Lene Weber Vestermark, Sven-Petter Haugvik, Morten Ladekarl, Seppo W Langer, H Grønbæk, Pia Österlund, G. O. Hjortland, J Assmus, L. Tang, A. Perren, H Sorbye

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Background: Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce. The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC. Methods: 32 patients with a diagnosis of high-grade gastroenteropancreatic neuroendocrine neoplasm (Ki-67 > 20%) and with intended curative resection/RFA of liver metastases, were identified among 840 patients from two Nordic GEP-NEC registries. Tumor morphology (well vs poor differentiation) was reassessed. Overall survival (OS) and progression-free survival (PFS) was assessed by Kaplan-Meier analyses for the entire cohort and for subgroups. Results: Median OS after resection/RFA of liver metastases was 35.9 months (95%-CI: 20.6-51.3) with a five-year OS of 43%. The median PFS was 8.4 months (95%-CI: 3.9-13). Four patients (13%) were disease-free after 5 years. Two patients had well-differentiated morphology (NET G3) and 20 patients (63%) had Ki-67 ≥ 55%. A Ki-67 < 55% and receiving adjuvant chemotherapy were statistically significant factors of improved OS after liver resection/RFA. Conclusion: This study shows a long median and long term survival after liver surgery/RFA for these selected metastatic GEP-NEC patients, particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Surgical Oncology
Vol/bind43
Udgave nummer9
Sider (fra-til)1682-1689
ISSN0748-7983
DOI
StatusUdgivet - 2017

Fingeraftryk

Liver
Disease-Free Survival
Adjuvant Chemotherapy
Registries
Neoplasms
Guidelines
Population

Citer dette

Galleberg, R. B. ; Knigge, U ; Tiensuu Janson, E. ; Weber Vestermark, Lene ; Haugvik, Sven-Petter ; Ladekarl, Morten ; Langer, Seppo W ; Grønbæk, H ; Österlund, Pia ; Hjortland, G. O. ; Assmus, J ; Tang, L. ; Perren, A. ; Sorbye, H. / Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas. I: European Journal of Surgical Oncology. 2017 ; Bind 43, Nr. 9. s. 1682-1689.
@article{b3e941d6c11f49818aa56024030d12b0,
title = "Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas",
abstract = "Background: Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce. The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC. Methods: 32 patients with a diagnosis of high-grade gastroenteropancreatic neuroendocrine neoplasm (Ki-67 > 20{\%}) and with intended curative resection/RFA of liver metastases, were identified among 840 patients from two Nordic GEP-NEC registries. Tumor morphology (well vs poor differentiation) was reassessed. Overall survival (OS) and progression-free survival (PFS) was assessed by Kaplan-Meier analyses for the entire cohort and for subgroups. Results: Median OS after resection/RFA of liver metastases was 35.9 months (95{\%}-CI: 20.6-51.3) with a five-year OS of 43{\%}. The median PFS was 8.4 months (95{\%}-CI: 3.9-13). Four patients (13{\%}) were disease-free after 5 years. Two patients had well-differentiated morphology (NET G3) and 20 patients (63{\%}) had Ki-67 ≥ 55{\%}. A Ki-67 < 55{\%} and receiving adjuvant chemotherapy were statistically significant factors of improved OS after liver resection/RFA. Conclusion: This study shows a long median and long term survival after liver surgery/RFA for these selected metastatic GEP-NEC patients, particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population.",
keywords = "Liver, Metastases, Neuroendocrine carcinoma, Surgery, Survival",
author = "Galleberg, {R. B.} and U Knigge and {Tiensuu Janson}, E. and {Weber Vestermark}, Lene and Sven-Petter Haugvik and Morten Ladekarl and Langer, {Seppo W} and H Gr{\o}nb{\ae}k and Pia {\"O}sterlund and Hjortland, {G. O.} and J Assmus and L. Tang and A. Perren and H Sorbye",
year = "2017",
doi = "10.1016/j.ejso.2017.04.010",
language = "English",
volume = "43",
pages = "1682--1689",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "Heinemann",
number = "9",

}

Galleberg, RB, Knigge, U, Tiensuu Janson, E, Weber Vestermark, L, Haugvik, S-P, Ladekarl, M, Langer, SW, Grønbæk, H, Österlund, P, Hjortland, GO, Assmus, J, Tang, L, Perren, A & Sorbye, H 2017, 'Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas', European Journal of Surgical Oncology, bind 43, nr. 9, s. 1682-1689. https://doi.org/10.1016/j.ejso.2017.04.010

Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas. / Galleberg, R. B.; Knigge, U; Tiensuu Janson, E.; Weber Vestermark, Lene; Haugvik, Sven-Petter; Ladekarl, Morten; Langer, Seppo W; Grønbæk, H; Österlund, Pia; Hjortland, G. O.; Assmus, J; Tang, L.; Perren, A.; Sorbye, H.

I: European Journal of Surgical Oncology, Bind 43, Nr. 9, 2017, s. 1682-1689.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas

AU - Galleberg, R. B.

AU - Knigge, U

AU - Tiensuu Janson, E.

AU - Weber Vestermark, Lene

AU - Haugvik, Sven-Petter

AU - Ladekarl, Morten

AU - Langer, Seppo W

AU - Grønbæk, H

AU - Österlund, Pia

AU - Hjortland, G. O.

AU - Assmus, J

AU - Tang, L.

AU - Perren, A.

AU - Sorbye, H

PY - 2017

Y1 - 2017

N2 - Background: Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce. The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC. Methods: 32 patients with a diagnosis of high-grade gastroenteropancreatic neuroendocrine neoplasm (Ki-67 > 20%) and with intended curative resection/RFA of liver metastases, were identified among 840 patients from two Nordic GEP-NEC registries. Tumor morphology (well vs poor differentiation) was reassessed. Overall survival (OS) and progression-free survival (PFS) was assessed by Kaplan-Meier analyses for the entire cohort and for subgroups. Results: Median OS after resection/RFA of liver metastases was 35.9 months (95%-CI: 20.6-51.3) with a five-year OS of 43%. The median PFS was 8.4 months (95%-CI: 3.9-13). Four patients (13%) were disease-free after 5 years. Two patients had well-differentiated morphology (NET G3) and 20 patients (63%) had Ki-67 ≥ 55%. A Ki-67 < 55% and receiving adjuvant chemotherapy were statistically significant factors of improved OS after liver resection/RFA. Conclusion: This study shows a long median and long term survival after liver surgery/RFA for these selected metastatic GEP-NEC patients, particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population.

AB - Background: Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce. The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC. Methods: 32 patients with a diagnosis of high-grade gastroenteropancreatic neuroendocrine neoplasm (Ki-67 > 20%) and with intended curative resection/RFA of liver metastases, were identified among 840 patients from two Nordic GEP-NEC registries. Tumor morphology (well vs poor differentiation) was reassessed. Overall survival (OS) and progression-free survival (PFS) was assessed by Kaplan-Meier analyses for the entire cohort and for subgroups. Results: Median OS after resection/RFA of liver metastases was 35.9 months (95%-CI: 20.6-51.3) with a five-year OS of 43%. The median PFS was 8.4 months (95%-CI: 3.9-13). Four patients (13%) were disease-free after 5 years. Two patients had well-differentiated morphology (NET G3) and 20 patients (63%) had Ki-67 ≥ 55%. A Ki-67 < 55% and receiving adjuvant chemotherapy were statistically significant factors of improved OS after liver resection/RFA. Conclusion: This study shows a long median and long term survival after liver surgery/RFA for these selected metastatic GEP-NEC patients, particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population.

KW - Liver

KW - Metastases

KW - Neuroendocrine carcinoma

KW - Surgery

KW - Survival

U2 - 10.1016/j.ejso.2017.04.010

DO - 10.1016/j.ejso.2017.04.010

M3 - Journal article

VL - 43

SP - 1682

EP - 1689

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

IS - 9

ER -