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. 2022 Mar 8:12:838103.
doi: 10.3389/fonc.2022.838103. eCollection 2022.

The Role of Primary Tumor Resection in Patients With Pancreatic Neuroendocrine Tumors With Liver Metastases

Yu Mou  1 , Zi-Yao Wang  1 , Chun-Lu Tan  1 , Yong-Hua Chen  1 , Xu-Bao Liu  1 , Neng-Wen Ke  1
Affiliations

The Role of Primary Tumor Resection in Patients With Pancreatic Neuroendocrine Tumors With Liver Metastases

Yu Mou et al. Front Oncol. .

Abstract

Background: Liver metastases (LMs) are common in advanced pancreatic neuroendocrine tumor (PNET) patients. Currently, the benefit of primary tumor resection (PTR) in the setting of PNET patients with liver metastases is still controversial in several guidelines.

Methods: Data were extracted from the Surveillance, Epidemiology and End Results (SEER) database to evaluate this issue. The main index of interest in our study was overall survival time.

Results: Information on 536 PNET patients with liver metastases from the SEER database was identified. A total of 214 patients (PTR group) received primary tumor resection, and more than half of them (132 patients) had synchronous LM resection. The other 322 PNET patients (non-PTR group) with liver metastases did not receive primary tumor resection. A significant survival benefit was gained from PTR when compared with non-PTR patients, both in OS (72.93 ± 2.7 vs. 36.80 ± 2.22 months) and 3- or 5-year survival rates (75.1% vs. 28.9% and 67.9% vs. 22.3%, respectively). No difference was found between PTR alone and PTR with synchronous LM resection. From univariate and multivariate analyses, younger age (<65 years) and good or moderate tumor differentiation may be more important when considering primary tumor resection. However, we found that all grades of tumor differentiation could result in a better overall survival time after primary tumor resection.

Conclusion: Our study suggested that primary tumor resection in pancreatic neuroendocrine patients with liver metastases could result in a longer survival time. Primary tumor resection with synchronous liver metastasis resection was not related to a better survival benefit. This treatment strategy may routinely be taken into consideration in these patients.

Keywords: liver metastases; overall survival (OS); pancreatic neuroendocrine tumors; primary tumor resection; tumor differentiation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patients selection.
Figure 2
Figure 2
Effect of primary tumor resection (A) and with/without liver metastases resection (B) in pancreatic neuroendocrine tumor patients with liver metastases.
Figure 3
Figure 3
Effect of primary tumor resection in patients with different tumor differentiation: (A) well-differentiated patients; (B) moderately differentiated patients; (C) poorly differentiated patients; and (D) undifferentiated patients.
Figure 4
Figure 4
Effect of primary tumor resection in patients with different tumor sizes: (A) tumor size ≤2 cm; (B) tumor size 2–4 cm; (C) tumor size >4 cm.
Figure 5
Figure 5
Overall survival time in patients who received different surgical procedures.
See this image and copyright information in PMC

References

    1. Yao JC, Eisner MP, Leary C, Dagohoy C, Phan A, Rashid A, et al. . Population-Based Study of Islet Cell Carcinoma. Ann Surg Oncol (2007) 14:3492–500. doi: 10.1245/s10434-007-9566-6 - DOI - PMC - PubMed
    1. Pavel M, Baudin E, Couvelard A, Krenning E, Öberget K, Steinmüller T, et al. . ENETS Consensus Guidelines for the Management of Patients With Liver and Other Distant Metastases From Neuroendocrine Neoplasms of Foregut, Midgut, Hindgut, and Unknown Primary. Neuroendocrinology (2012) 95:157–76. doi: 10.1159/000335597 - DOI - PubMed
    1. Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, et al. . One Hundred Years After “Carcinoid”: Epidemiology of and Prognostic Factors for Neuroendocrine Tumors in 35,825 Cases in the United States. J Clin Oncol (2008) 26:3063–72. doi: 10.1200/JCO.2007.15.4377 - DOI - PubMed
    1. Zhou B, Zhan C, Ding Y, Yan S, Zheng S. Role of Palliative Resection of the Primary Pancreatic Neuroendocrine Tumor in Patients With Unresectable Metastatic Liver Disease: A Systematic Review and Meta-Analysis. Onco Targets Ther (2018) 11:975–82. doi: 10.2147/OTT.S158171 - DOI - PMC - PubMed
    1. Partelli S, Cirocchi R, Rancoita PMV, Muffatti F, Andreasi V, Crippa S, et al. . A Systematic Review and Meta-Analysis on the Role of Palliative Primary Resection for Pancreatic Neuroendocrine Neoplasm With Liver Metastases. HPB (Oxford) (2018) 20:197–203. doi: 10.1016/j.hpb.2017.10.014 - DOI - PubMed

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