Background
Pancreatic neuroendocrine tumors (PNETs) present in more than 50% of cases with liver
metastases as the only systemic localization. Liver metastases are unresectable in
80% of cases at diagnosis. In the context of a metastatic disease, the benefit of
primary tumor removal in terms of survival is controversial.
Methods
A single-center series of patients with PNETs presenting with synchronous unresectable
hepaticmetastases and treated within a framework of a multidisciplinary team was analyzed
retrospectively to assess the prognostic factors and the potential benefit of primary
tumor resection on long-term survival.
Results
At the time of diagnosis, 12 of 43 patients (28%) underwent primary tumor resection.
After a median follow-up of 5 years (range, 0.6–14 years), 22 disease-related deaths
were observed. The corresponding 5-year survival and median disease-specific duration
of survival were 58% and 77 months, respectively. In the operated and nonoperated
patients the 5-year disease-specific survival was 82% and 50%, respectively (P = .027). At multivariate analysis, patients with primary tumor removed had an improved
survival compared with patients who did not (hazard ratio 0.18; 95% CI 0.05–0.66;
P = .010). Other important factors associated with improved survival at multivariate
analysis were lesser age, lesser Ki-67 index, and 25% less liver tumor burden.
Conclusion
In the present series of patients with PNETs and unresectable liver metastases, resection
of the primary tumor was associated with an improved survival. This observation suggests
that resection of the primary tumor should be part of a global therapeutic strategy
and its indication and timing should be discussed within a multidisciplinary team.
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Article info
Publication history
Published online: December 26, 2013
Accepted:
December 19,
2013
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
