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. 2020 Feb;9(1):1-12.
doi: 10.21037/hbsn.2019.06.02.

Radiographic characteristics of neuroendocrine liver metastases do not predict clinical outcomes following liver resection

Emily A Armstrong  1 , Eliza W Beal  2 , Manisha Shah  3 , Bhavana Konda  3 , Sherif Abdel-Misih  2 , Aslam Ejaz  2 , Mary E Dillhoff  2 , Timothy M Pawlik  2 , Jordan M Cloyd  2
Affiliations

Radiographic characteristics of neuroendocrine liver metastases do not predict clinical outcomes following liver resection

Emily A Armstrong et al. Hepatobiliary Surg Nutr. 2020 Feb.

Abstract

Background: Previous research has demonstrated that specific radiographic criteria, including the presence of calcifications and the enhancement pattern on computed tomography (CT) imaging, correlates with clinicopathologic features and outcomes of patients with gastroenteropancreatic neuroendocrine tumors (NET). We sought to investigate whether these radiographic characteristics were prognostic among patients with neuroendocrine liver metastases (NELM) undergoing surgical resection.

Methods: The preoperative contrast-enhanced CT scans of all patients who underwent resection of NELM at a single institution between 2000-2015 were retrospectively reviewed. The presence of calcifications was determined on non-contrast phase imaging. Enhancement on the arterial phase scan was categorized as hyperenhancing, hypoenhancing, or mixed. Relevant clinicopathologic characteristics as well as recurrence-free survival (RFS) and overall survival (OS) were compared between groups.

Results: Among 82 patients who underwent resection of NELM, 57 had available data on calcifications while 51 had data available on arterial enhancement patterns. Among all patients, median age was 58 (IQR: 47-63) and the majority were female (N=48, 59.5%). The most common primary tumor locations were pancreas (N=25, 30.5%) and small bowel (N=27, 32.9%). The most commonly performed operations were right hepatectomy (N=29, 35.4%), bisegmentectomy (N=15, 18.3%), and segmentectomy (N=14, 17.1%). Median tumor number was 4 (IQR: 2-9), median Ki-67 was 5% (IQR: 2-10%), and median size of the largest liver metastasis was 4.5 (IQR: 2.8-7.7) cm. Twelve (21%) patients had tumor calcifications. Among patients with and without calcifications there were no differences in demographics, clinicopathologic characteristics, RFS (P=0.772) or OS (P=0.095). Arterial enhancement was hypoenhancing in 23 (45.1%), hyperenhancing in 10 (19.6%), and mixed in 18 (35.3%). Similarly, there were no differences between arterial enhancement groups in demographics, clinicopathologic characteristics, RFS (P=0.618) or OS (P=0.268).

Conclusions: Radiographic characteristics on contrast-enhanced CT are not associated with the outcomes of patients undergoing resection of NELM. Future investigations should evaluate the prognostic impact of functional neuroendocrine imaging.

Keywords: Neuroendocrine tumor (NET); carcinoid; hepatectomy; prognosis; radiomics.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Neuroendocrine liver metastasis. (A) With arterial enhancement; (B) without arterial enhancement; (C) with mixed enhancement; (D) with calcifications; (E) without calcifications.
Figure 2
Figure 2
Kaplan-Meier curve demonstrating. (A) Recurrence-free survival (RFS) (log-rank P=0.772); and (B) overall survival (OS) (log-rank P=0.095) from first liver resection for neuroendocrine liver metastasis comparing calcification groups.
Figure 3
Figure 3
Kaplan-Meier curve demonstrating (A) Recurrence-free survival (RFS) (log-rank P=0.618); and (B) overall survival (OS) (log-rank P=0.268) from first liver resection for neuroendocrine liver metastasis comparing arterial enhancement groups.
See this image and copyright information in PMC

Comment in

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