ASO Author Reflections: Assessing the Value of Primary Tumor Resection in Midgut Neuroendocrine Tumors with Liver-Only M
- PDF / 192,390 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 28 Downloads / 171 Views
ASO AUTHOR REFLECTIONS
ASO Author Reflections: Assessing the Value of Primary Tumor Resection in Midgut Neuroendocrine Tumors with Liver-Only Metastases Nicholas Manguso, MD, and Alexandra Gangi, MD, FACS Division of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
PAST
PRESENT
Midgut neuroendocrine tumors (MNETS) are thought to be slow-growing, indolent tumors that are asymptomatic and may remain undiagnosed until patients develop symptoms from obstruction, ischemia or bleeding, or until they have metastasized. As such, a large proportion of patients are found to have distant metastases, most frequently to the liver, at the time of diagnosis. For patients with synchronous liver metastases, as many as 80% are unresectable at diagnosis.1 Management of these complex patients has most often involved a combination of systemic therapies and liver-directed treatments (i.e. resection/debulking, ablation, peptide receptor radionuclide therapy [PRRT]) to manage symptoms and slow disease progression.2,3 Currently, recommendations regarding management of the primary tumor in the setting of unresectable liver metastases are limited and focus only on patients who are symptomatic from the primary tumor (pain, obstruction, bleeding).4 Understanding the value of primary tumor resection in patients who do not undergo metastatectomy has been a challenge as most data are limited to small institutional studies or studies including a limited number of patients.5
Using the National Cancer Database, this study identified patients with MNETs and liver-only metastases not undergoing liver resection (N = 1954) and compared outcomes between patients undergoing primary tumor resection (n = 1289, 66.0%) with those not undergoing resection (n = 665, 44.0%). Those patients who underwent primary tumor resection had a significantly better overall survival (OS; 5-year OS 66.5% vs. 49.5%; p \ 0.0001). Clinical T stage was used as a measure to compare groups, as pathologic T stage was only available for those who underwent resection. When these patients were compared based on clinical T stage, no difference was noted between those with T1 or T2 tumors; however, in both the T3 and T4 groups, patients who underwent primary tumor resection had a significantly better OS (T3, p = 0.005; T4, p \ 0.0001). Furthermore, primary tumor resection was a predictor of better survival (hazard ratio 0.64; p = 0.04). This is the largest study to date to assess the outcomes of primary tumor resection for MNETs with liver-only metastases, and suggests that primary tumor resection may provide a survival advantage in carefully selected patients.6 FUTURE
Ó Society of Surgical Oncology 2020 First Received: 2 June 2020 A. Gangi, MD, FACS e-mail: [email protected]
The current study addresses an important clinical question of resection of the primary tumor without cytoreduction of metastatic disease. Should primary tumor resection be performed in patients with unresectable liver disease? In those with symptoms, the answer is simple as resection red
Data Loading...
