The impact of extrahepatic disease among patients undergoing liver-directed therapy for neuroendocrine liver metastasis

Aslam Ejaz, Bradley N Reames, Shishir Maithel, George A. Poultsides, Todd W. Bauer, Ryan C. Fields, Matt Weiss, Hugo Pinto Marques, Luca Aldrighetti, Timothy M. Pawlik

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: Management of neuroendocrine liver metastasis (NELM) in the presence of extrahepatic disease (EHD) is controversial. We sought to examine outcomes of patients undergoing liver-directed therapy (resection, ablation, or both) for NELM in the presence of EHD using a large international cohort of patients. Methods: 612 patients who underwent liver-directed therapy were identified from eight institutions. Postoperative outcomes, as well as and overall (OS) were compared among patients with and without EHD. Results: Most primary tumors were located in the pancreas (N = 254;41.8%) or the small bowel (N = 188;30.9%). Patients underwent surgery alone (N = 471;77.0%), ablation alone (N = 15;2.5%), or a combined approach (N = 126;20.6%). Patients with EHD had more high-grade tumors (EHD: 44.4% vs no EHD: 16.1%; P < 0.001). EHD was often the peritoneum (N = 29;41.4%) or lung (N = 19;27.1%). Among 70 patients with EHD, 20.0% (N = 14) underwent concurrent resection for EHD. After median follow-up of 51 months, 174 (28.4%) patients died with a median OS of 140.4 months. Patients with EHD had a shorter median OS versus patients who did not have EHD (EHD: 87 months vs no EHD: not reached; P = 0.002). EHD was independently associated with an increased risk of death (HR: 2.56, 95%CI 1.16-5.62; P = 0.02). Conclusion: Patients with NELM and EHD had more aggressive tumors, conferring a twofold increased risk of death. Surgical treatment of NELM among patients with EHD should be individualized.

Original languageEnglish (US)
Pages (from-to)841-847
Number of pages7
JournalJournal of Surgical Oncology
Volume116
Issue number7
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Neoplasm Metastasis
Liver
Therapeutics
Neoplasms
Peritoneum
Pancreas
Lung

Keywords

  • extrahepatic
  • liver
  • metastasis
  • neuroendocrine

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

The impact of extrahepatic disease among patients undergoing liver-directed therapy for neuroendocrine liver metastasis. / Ejaz, Aslam; Reames, Bradley N; Maithel, Shishir; Poultsides, George A.; Bauer, Todd W.; Fields, Ryan C.; Weiss, Matt; Marques, Hugo Pinto; Aldrighetti, Luca; Pawlik, Timothy M.

In: Journal of Surgical Oncology, Vol. 116, No. 7, 01.12.2017, p. 841-847.

Research output: Contribution to journalArticle

Ejaz, A, Reames, BN, Maithel, S, Poultsides, GA, Bauer, TW, Fields, RC, Weiss, M, Marques, HP, Aldrighetti, L & Pawlik, TM 2017, 'The impact of extrahepatic disease among patients undergoing liver-directed therapy for neuroendocrine liver metastasis', Journal of Surgical Oncology, vol. 116, no. 7, pp. 841-847. https://doi.org/10.1002/jso.24727
Ejaz, Aslam ; Reames, Bradley N ; Maithel, Shishir ; Poultsides, George A. ; Bauer, Todd W. ; Fields, Ryan C. ; Weiss, Matt ; Marques, Hugo Pinto ; Aldrighetti, Luca ; Pawlik, Timothy M. / The impact of extrahepatic disease among patients undergoing liver-directed therapy for neuroendocrine liver metastasis. In: Journal of Surgical Oncology. 2017 ; Vol. 116, No. 7. pp. 841-847.
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abstract = "Introduction: Management of neuroendocrine liver metastasis (NELM) in the presence of extrahepatic disease (EHD) is controversial. We sought to examine outcomes of patients undergoing liver-directed therapy (resection, ablation, or both) for NELM in the presence of EHD using a large international cohort of patients. Methods: 612 patients who underwent liver-directed therapy were identified from eight institutions. Postoperative outcomes, as well as and overall (OS) were compared among patients with and without EHD. Results: Most primary tumors were located in the pancreas (N = 254;41.8{\%}) or the small bowel (N = 188;30.9{\%}). Patients underwent surgery alone (N = 471;77.0{\%}), ablation alone (N = 15;2.5{\%}), or a combined approach (N = 126;20.6{\%}). Patients with EHD had more high-grade tumors (EHD: 44.4{\%} vs no EHD: 16.1{\%}; P < 0.001). EHD was often the peritoneum (N = 29;41.4{\%}) or lung (N = 19;27.1{\%}). Among 70 patients with EHD, 20.0{\%} (N = 14) underwent concurrent resection for EHD. After median follow-up of 51 months, 174 (28.4{\%}) patients died with a median OS of 140.4 months. Patients with EHD had a shorter median OS versus patients who did not have EHD (EHD: 87 months vs no EHD: not reached; P = 0.002). EHD was independently associated with an increased risk of death (HR: 2.56, 95{\%}CI 1.16-5.62; P = 0.02). Conclusion: Patients with NELM and EHD had more aggressive tumors, conferring a twofold increased risk of death. Surgical treatment of NELM among patients with EHD should be individualized.",
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T1 - The impact of extrahepatic disease among patients undergoing liver-directed therapy for neuroendocrine liver metastasis

AU - Ejaz, Aslam

AU - Reames, Bradley N

AU - Maithel, Shishir

AU - Poultsides, George A.

AU - Bauer, Todd W.

AU - Fields, Ryan C.

AU - Weiss, Matt

AU - Marques, Hugo Pinto

AU - Aldrighetti, Luca

AU - Pawlik, Timothy M.

PY - 2017/12/1

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N2 - Introduction: Management of neuroendocrine liver metastasis (NELM) in the presence of extrahepatic disease (EHD) is controversial. We sought to examine outcomes of patients undergoing liver-directed therapy (resection, ablation, or both) for NELM in the presence of EHD using a large international cohort of patients. Methods: 612 patients who underwent liver-directed therapy were identified from eight institutions. Postoperative outcomes, as well as and overall (OS) were compared among patients with and without EHD. Results: Most primary tumors were located in the pancreas (N = 254;41.8%) or the small bowel (N = 188;30.9%). Patients underwent surgery alone (N = 471;77.0%), ablation alone (N = 15;2.5%), or a combined approach (N = 126;20.6%). Patients with EHD had more high-grade tumors (EHD: 44.4% vs no EHD: 16.1%; P < 0.001). EHD was often the peritoneum (N = 29;41.4%) or lung (N = 19;27.1%). Among 70 patients with EHD, 20.0% (N = 14) underwent concurrent resection for EHD. After median follow-up of 51 months, 174 (28.4%) patients died with a median OS of 140.4 months. Patients with EHD had a shorter median OS versus patients who did not have EHD (EHD: 87 months vs no EHD: not reached; P = 0.002). EHD was independently associated with an increased risk of death (HR: 2.56, 95%CI 1.16-5.62; P = 0.02). Conclusion: Patients with NELM and EHD had more aggressive tumors, conferring a twofold increased risk of death. Surgical treatment of NELM among patients with EHD should be individualized.

AB - Introduction: Management of neuroendocrine liver metastasis (NELM) in the presence of extrahepatic disease (EHD) is controversial. We sought to examine outcomes of patients undergoing liver-directed therapy (resection, ablation, or both) for NELM in the presence of EHD using a large international cohort of patients. Methods: 612 patients who underwent liver-directed therapy were identified from eight institutions. Postoperative outcomes, as well as and overall (OS) were compared among patients with and without EHD. Results: Most primary tumors were located in the pancreas (N = 254;41.8%) or the small bowel (N = 188;30.9%). Patients underwent surgery alone (N = 471;77.0%), ablation alone (N = 15;2.5%), or a combined approach (N = 126;20.6%). Patients with EHD had more high-grade tumors (EHD: 44.4% vs no EHD: 16.1%; P < 0.001). EHD was often the peritoneum (N = 29;41.4%) or lung (N = 19;27.1%). Among 70 patients with EHD, 20.0% (N = 14) underwent concurrent resection for EHD. After median follow-up of 51 months, 174 (28.4%) patients died with a median OS of 140.4 months. Patients with EHD had a shorter median OS versus patients who did not have EHD (EHD: 87 months vs no EHD: not reached; P = 0.002). EHD was independently associated with an increased risk of death (HR: 2.56, 95%CI 1.16-5.62; P = 0.02). Conclusion: Patients with NELM and EHD had more aggressive tumors, conferring a twofold increased risk of death. Surgical treatment of NELM among patients with EHD should be individualized.

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KW - liver

KW - metastasis

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