ASO Author Reflections: A Nomogram to Predict Recurrence after Curative-Intent Resection for Neuroendocrine Liver Metast
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: A Nomogram to Predict Recurrence after Curative-Intent Resection for Neuroendocrine Liver Metastasis Diamantis I. Tsilimigras, MD1, Jun-Xi Xiang, MD2, Xu-Feng Zhang, MD, PhD1,2, and Timothy M. Pawlik, MD, MPH, PhD1 1
Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH; 2Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
PAST
PRESENT
The European Neuroendocrine Tumor Society (ENETS) guidelines recommend resection of neuroendocrine liver metastasis (NELM) when NELM originate from well- or moderately differentiated primary tumors and when at least 90% of the tumor burden can be safely removed.1 Although surgical resection is the mainstay of treatment for patients with resectable NELM, up to 70–80% of patients with NELM will relapse or experience disease progression following liver resection.2–4 Therefore, there is a need for better risk stratification and accurate prediction of recurrence among patients who undergo curative-intent resection for NELM. By utilizing a large international, multi-institutional cohort, we sought to develop and validate a nomogram to estimate patient prognosis after liver resection for NELM.5
A total of 377 patients underwent curative-intent resection of NELM during the study period (training cohort: 279, validation cohort: 98). Primary tumor location included the pancreas in the majority of patients (47.7%) followed by small bowel (33.4%), colon (6.6%), and others. Among 279 patients in the training cohort, 1-, 3-, and 5-year RFS following liver resection was 77.5%, 57.8%, and 48.7%, respectively. Primary tumor location (pancreatic versus nonpancreatic, HR 2.1, 95% CI 1.3–3.4), tumor grade (ref: well; moderate, HR 1.9, 95% CI 1.1–3.1; poor, HR 1.6, 95% CI 0.7–3.3), lymph node metastasis (LNM) (HR 2.6, 95% CI 1.4–4.6), and extent of resection (major versus parenchymal-sparing resection, HR 0.3, 95% CI 0.1–0.6) independently predicted tumor recurrence. A nomogram including these four variables (i.e., primary tumor location, differentiation grade, LNM, and extent of resection) was developed to predict prognosis and demonstrated very good performance in the training (Cindex: 0.754) and validation cohorts (C-index: 0.748). The discriminatory ability of the nomogram was also very good regarding the prediction of 3-year RFS (C-index; training: 0.795, validation: 0.637) and 5-year RFS (C-index; training: 0.832, validation: 0.812).
This ASO Author Reflections is a brief invited commentary on the article, ‘‘Multi-institutional Development and External Validation of a Nomogram Predicting Recurrence after Curative Liver Resection for Neuroendocrine Liver Metastasis,’’ Ann Surg Oncol. 2020. https://d oi.org/10.1245/s10434-020-08620-5. Ó Society of Surgical Oncology 2020 First Received: 10 April 2020 T. M. Pawlik, MD, MPH, PhD e-mail:
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