Document Detail


Liver transplantation for neuroendocrine tumors in Europe-results and trends in patient selection: a 213-case European liver transplant registry study.
MedLine Citation:
PMID:  23532105     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to assess outcomes and indications in a large cohort of patients who underwent liver transplantation (LT) for liver metastases (LM) from neuroendocrine tumors (NET) over a 27-year period.
BACKGROUND: LT for NET remains controversial due to the absence of clear selection criteria and the scarcity and heterogeneity of reported cases.
METHODS: This retrospective multicentric study included 213 patients who underwent LT for NET performed in 35 centers in 11 European countries between 1982 and 2009. One hundred seven patients underwent transplantation before 2000 and 106 after 2000. Mean age at the time of LT was 46 years. Half of the patients presented hormone secretion and 55% had hepatomegaly. Before LT, 83% of patients had undergone surgical treatment of the primary tumor and/or LM and 76% had received chemotherapy. The median interval between diagnosis of LM and LT was 25 months (range, 1-149 months). In addition to LT, 24 patients underwent major resection procedures and 30 patients underwent minor resection procedures.
RESULTS: Three-month postoperative mortality was 10%. At 5 years after LT, overall survival (OS) was 52% and disease-free survival was 30%. At 5 years from diagnosis of LM, OS was 73%. Multivariate analysis identified 3 predictors of poor outcome, that is, major resection in addition to LT, poor tumor differentiation, and hepatomegaly. Since 2000, 5-year OS has increased to 59% in relation with fewer patients presenting poor prognostic factors. Multivariate analysis of the 106 cases treated since 2000 identified the following predictors of poor outcome: hepatomegaly, age more than 45 years, and any amount of resection concurrent with LT.
CONCLUSIONS: LT is an effective treatment of unresectable LM from NET. Patient selection based on the aforementioned predictors can achieve a 5-year OS between 60% and 80%. However, use of overly restrictive criteria may deny LT to some patients who could benefit. Optimal timing for LT in patients with stable versus progressive disease remains unclear.
Authors:
Yves Patrice Le Treut; Emilie Grégoire; Jürgen Klempnauer; Jacques Belghiti; Elisabeth Jouve; Jan Lerut; Denis Castaing; Olivier Soubrane; Olivier Boillot; Georges Mantion; Kia Homayounfar; Manuel Bustamante; Daniel Azoulay; Philippe Wolf; Marek Krawczyk; Andreas Pascher; Bertrand Suc; Laurence Chiche; Jorge Ortiz de Urbina; Vladimir Mejzlik; Manuel Pascual; J Peter A Lodge; Salvatore Gruttadauria; François Paye; François-René Pruvot; Stefan Thorban; Aksel Foss; René Adam;
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of surgery     Volume:  257     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-11     Completed Date:  2013-06-03     Revised Date:  2013-09-04    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  807-15     Citation Subset:  AIM; IM    
Affiliation:
Hôpital La Conception, Marseille, France.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Europe
Female
Follow-Up Studies
Humans
Liver Neoplasms / mortality,  secondary*,  surgery*
Liver Transplantation*
Male
Middle Aged
Multivariate Analysis
Neuroendocrine Tumors / mortality,  secondary*,  surgery*
Patient Selection*
Prognosis
Registries
Retrospective Studies
Survival Analysis
Treatment Outcome
Young Adult
Comments/Corrections
Comment In:
Ann Surg. 2013 May;257(5):816-7   [PMID:  23532106 ]
Chirurg. 2013 Jul;84(7):600   [PMID:  23743994 ]

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