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Published in: Journal of Gastrointestinal Surgery 11/2017

01-11-2017 | Original Article

Early Recurrence of Neuroendocrine Liver Metastasis After Curative Hepatectomy: Risk Factors, Prognosis, and Treatment

Authors: Xu-Feng Zhang, Eliza W. Beal, Jeffery Chakedis, Yi Lv, Fabio Bagante, Luca Aldrighetti, George A. Poultsides, Todd W. Bauer, Ryan C. Fields, Shishir Kumar Maithel, Hugo P. Marques, Matthew Weiss, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 11/2017

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Abstract

Background

Early tumor recurrence after curative resection typically indicates a poor prognosis. The objective of the current study was to investigate the risk factors, treatment, and prognosis of early recurrence of neuroendocrine tumor (NET) liver metastasis (NELM) after hepatic resection.

Methods

A total of 481 patients who underwent curative-intent resection for NELM were identified from a multi-institutional database. Data on clinicopathological characteristics, intraoperative details, and outcomes were documented. The optimal cutoff value to differentiate early and late recurrence was determined to be 3 years based on linear regression.

Results

With a median follow-up of 60 months, 223 (46.4%) patients developed a recurrence, including 158 (70.9%) early and 65 (29.1%) late recurrences. On multivariable analysis, pancreatic NET, primary tumor lymph node metastasis, and a microscopic positive surgical margin were independent risk factors for early intrahepatic recurrence. While recurrence patterns and treatments were comparable among patients with early and late recurrences, early recurrence was associated with worse disease-specific survival than late recurrences (10-year NELM-specific survival, 44.5 vs 75.8%, p < 0.001). Among the 34 (21.5%) patients who underwent curative treatment for early recurrence, post-recurrence disease-specific survival was better than non-curatively treated patients (10-year NELM-specific survival, 54.2 vs 26.3%, p = 0.028), yet similar to patients with late recurrences treated with curative intent (10-year NELM-specific survival, 54.2 vs 37.4%, p = 0.519).

Conclusions

Early recurrence after surgery for NELM was associated with the pancreatic type, primary lymph node metastasis, and extrahepatic disease. Re-treatment with curative intent prolonged survival after recurrence, and therefore, operative intervention even for early recurrences of NELM should be considered.
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Metadata
Title
Early Recurrence of Neuroendocrine Liver Metastasis After Curative Hepatectomy: Risk Factors, Prognosis, and Treatment
Authors
Xu-Feng Zhang
Eliza W. Beal
Jeffery Chakedis
Yi Lv
Fabio Bagante
Luca Aldrighetti
George A. Poultsides
Todd W. Bauer
Ryan C. Fields
Shishir Kumar Maithel
Hugo P. Marques
Matthew Weiss
Timothy M. Pawlik
Publication date
01-11-2017
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 11/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-017-3490-2

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