Midgut Neuroendocrine Tumors with Liver-only Metastases: Benefit of Primary Tumor Resection
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ORIGINAL ARTICLE – ENDOCRINE TUMORS
Midgut Neuroendocrine Tumors with Liver-only Metastases: Benefit of Primary Tumor Resection Alexandra Gangi, MD1, Nicholas Manguso, MD2, Jun Gong, MD3, Jessica S. Crystal, MD1, Shirley C. Paski, MD, MSc, FRCPC4, Andrew E. Hendifar, MD3, and Richard Tuli, MD, PhD5,6 1
Division of Surgical Oncology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; 2Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; 3Department of Gastrointestinal Malignancies, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; 4Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA; 5Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA; 6Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
ABSTRACT Background. Management of metastatic midgut neuroendocrine tumors (MNET) remains controversial. The benefits of resecting the primary tumor are not clear and advocated only for select patients. This study aimed to determine whether resection of the primary MNET in patients with untreated liver-only metastases has an impact on survival. Methods. This retrospective study reviewed data of the National Cancer Database from 2004 to 2015 for patients with liver-only metastatic MNETs and compared those who received resection of their primary MNET with those who did not. Patient demographics, tumor characteristics, and clinical outcomes were compared between the groups. The primary outcome was overall survival (OS) after adjustment for patient, demographic, and tumor-related factors. Results. The study identified 1952 patients with a median age of 63 years (range, 18–90 years). The median primary tumor size was 2.4 cm (range, 0.1–20 cm). Of these patients, 1295 (66%) underwent resection of the primary tumor and 667 (34%) did not. The patients who underwent resection were younger (median age, 63 vs 65 years; p \ 0.001) and had smaller primary tumors (median, 2.3 vs
Ó Society of Surgical Oncology 2020 First Received: 6 September 2019 A. Gangi, MD e-mail: [email protected]
3.0 cm; p \ 0.001). The patients with clinical T1 or T2 tumors were significantly less likely to undergo resection than those with stage T3 or T4 tumors (58.5% vs 89.7%; p \ 0.001). The median follow-up period was 43 months (range, 1–83 months). In the entire cohort, 483 deaths occurred, with a 5-year OS of 61%. The 5-year OS rate was 49% for the patients who underwent resection and 66% for those who did not (p \ 0.001). When the patients were grouped according to T stage, no OS difference between resection and no resection for stages T1 (p = 0.07) and T2 (p = 0.40) was identified. However, the 5-year OS rate was significantly better for the resected patient cohort with T3 (67.5% vs 37.2%; p \ 0.001) or T4 (59.8% vs 21.5%; p \ 0.001) tumors. Conclusions. The patients with treatment-naı¨ve liver-only metastatic MNET had improved OS when the primary
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