Prognosis of Resected Neuroendocrine Metastases: A Complex Puzzle Can Only be Solved One Small Piece at a Time

Excerpt

Many aspects of care for patients with gastrointestinal neuroendocrine tumors present challenges and uncertainties for clinicians. This is true for the entire spectrum of possible presentations spanning a wide range—from management of small, incidentally discovered duodenal or pancreatic tumors, to that of liver metastases. In this issue of Annals of Surgical Oncology, Xiang and colleagues attempt to deepen our understanding of prognosis (expressed using disease-free survival [DFS]) after curative liver resection of neuroendocrine liver metastasis by developing a novel nomogram, a first for this subgroup of patients.1 Considering the relative rarity of the disease, those researchers have assembled a robust collaborative group: six institutions provided data for the development set, consisting of 279 patients, and two institutions formed the validation set of 98 patients. The multi-institutional nature of the study and the ability to analyze prognostic factors in a large cohort is clearly one of the strengths of this study. It allowed the authors to perform a multivariable analysis and identify several prognostic variables associated with DFS. …