Liver Transplantation for Hepatic Metastases of Neuroendocrine Pancreatic Tumors: A Survival-Based Analysis

Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstrasse 55, Essen, Germany.
Transplantation (Impact Factor: 3.83). 03/2011; 91(5):575-82. DOI: 10.1097/TP.0b013e3182081312
Source: PubMed


Liver transplantation (LT) has been accepted as a treatment in selected cases of neuroendocrine tumors (NETs) with hepatic metastases.
A systematic review of the literature was conducted to evaluate long-term patient survival in the instances of LT for pancreatic NET. Univariate and multivariate regression analyses and survival analysis were performed.
Fifty-three clinical studies were screened. Data from 20 studies encompassing 89 transplanted patients were included in the study. Most primary tumors were endocrine pancreatic tumors (n=69), with gastrinomas representing the most frequent diagnosis (n=21). There were 61 functioning pancreatic NET. Simultaneous LT and pancreatic NET resections were performed in 45 instances. Cumulative 1-, 3-, and 5-year survival was 71%, 55%, and 44%, respectively, with a calculated mean survival of 54.45±6.31 months. Vasoactive intestinal peptide (VIPomas) had the best overall survival. Recurrence-free survival at 1, 3, and 5 years was 84%, 47%, and 47%, respectively. Recipient age more than or equal to 55 years (P=0.0242) and simultaneous LT-pancreatic resection (P=0.0132) were found to be significant predictors of worse survival by both univariate and multivariate Cox proportional hazard analyses. A scoring system was developed, with prognostic points assigned as follows: age more than or equal to 55 years:age less than 55 years=1:0 points and simultaneous LT-pancreatic resection:LT alone=1:0 points. This stratification delineated three separate population samples corresponding to patients with scores of 0, 1, and 2, respectively. The calculated 5-year survival for scores 0, 1, and 2 was 61%, 40%, and 0%, respectively (P=0.0023).
Despite the limitations of this retrospective analysis, good results can be achieved even for pancreatic NET primaries if the above-proposed scoring system is applied.

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    • "In patients >55 undergoing resection of the primary pancreatic lesion at the same time as OLT, there was a 0% 5-year survival. Accordingly, the authors recommended that patient selection for transplant account for age and simultaneous extrahepatic resections [35]. This finding was corroborated in a multicenter French study by Le Treut et al. in 85 cases of OLT for NETs, 34 of the patients underwent concurrent resection of extrahepatic disease, and 7 of whom required upper abdominal exenteration (resection of the pancreas, spleen, stomach, and duodenum, with 3 patients receiving en bloc composite liver-duodenum-pancreas grafts). "
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    ABSTRACT: In the care of patients with hepatic neuroendocrine metastases, medical oncologists should work in multidisciplinary fashion with surgeons, interventional radiologists, and radiation oncologists to assess the potential utility of liver-directed and systemic therapies. This paper addresses the various roles and evidence basis for cytoreductive surgery, thermal ablation (radiofrequency, microwave, and cryoablation), and embolization (bland embolization (HAE), chemoembolization (HACE), and radioembolization) as liver-directed therapies. Somatostatin analogues, cytotoxic chemotherapy, and the newer agents everolimus and suntinib are discussed as a means for controlling intra- and extrahepatic disease, along with peptide receptor radiotherapy (PRRT). Finally, the experience with orthotopic liver transplant for neuroendocrine tumors is described.
    11/2012; 2012(3):973946. DOI:10.1155/2012/973946
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    • "If patients were 55 years old or younger and were not undergoing simultaneous pancreatic resection, then their predicted 5-year survival was 61%. Conversely, a 0% 5-year survival rate was prognosticated for patients older than 55 who were undergoing resection of the primary pancreatic lesion at the same time as transplantation [77]. The largest single-center experience with liver transplantation for NETs reports a 10-year survival rate of 50% among 19 patients. "
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    10/2011; 2011:452343. DOI:10.4061/2011/452343
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    Hepatobiliary & pancreatic diseases international: HBPD INT 06/2011; 10(3):243-7. DOI:10.1016/S1499-3872(11)60040-4 · 1.17 Impact Factor
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