Neuroendocrine hepatic metastases: does aggressive management improve survival?

Abstract

Objective: The aim of this study was to determine whether aggressive management of neuroendocrine hepatic metastases improves survival.

Summary background data: Survival in patients with carcinoid and pancreatic neuroendocrine tumors is significantly better than adenocarcinomas arising from the same organs. However, survival and quality of life are diminished in patients with neuroendocrine hepatic metastases. In recent years, aggressive treatment of hepatic neuroendocrine tumors has been shown to relieve symptoms. Minimal data are available, however, to document improved survival with this approach.

Methods: The records of patients with carcinoid (n = 84) and pancreatic neuroendocrine tumors (n = 69) managed at our institution from January 1990 through July 2004 were reviewed. Eighty-four patients had malignant tumors, and hepatic metastases were present in 60 of these patients. Of these 60 patients, 23 received no aggressive treatment of their liver metastases, 19 were treated with hepatic resection and/or ablation, and 18 were managed with transarterial chemoembolization (TACE) frequently (n = 11) in addition to resection and/or ablation. These groups did not differ with respect to age, gender, tumor type, or extent of liver involvement.

Results: Median and 5-year survival were 20 months and 25% for the Nonaggressive group, >96 months and 72% for the Resection/Ablation group, and 50 months and 50% for the TACE group. The survival for the Resection/Ablation and the TACE groups was significantly better (P < 0.05) when compared with the Nonaggressive group. Patients with more than 50% liver involvement had a poor outcome (P < 0.001).

Conclusions: These data suggest that aggressive management of neuroendocrine hepatic metastases does improve survival, that chemoembolization increases the patient population eligible for this strategy, and that patients with more than 50% liver involvement may not benefit from an aggressive approach.

FIGURE 1. A, Kaplan-Meier actuarial survival curve comparing patients with benign (n = 69) and malignant (n = 84) tumors. Survival was better (P < 0.001) in the patients with benign tumors. B, Kaplan-Meier actuarial survival curve comparing patients with hepatic metastases with carcinoid (n = 36) and pancreatic (n = 24) tumors. No difference in survival was observed.

FIGURE 2. Kaplan-Meier actuarial survival curve comparing Resection/Ablation (RA), TACE ± RA (TRA), and Nonaggressive (NON) treatments. Survival was significantly improved (P < 0.05) in the RA and TRA groups.

FIGURE 3. Kaplan-Meier actuarial survival curve comparing extent of liver disease by 50% involvement. Survival was significantly better (P < 0.001) if less than 50% of the liver was involved.