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

Aslam Ejaz, Brad 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

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Neoplasm Metastasis
Liver
Therapeutics
Neoplasms
Peritoneum
Pancreas
Lung

Keywords

  • extrahepatic
  • liver
  • metastasis
  • neuroendocrine

ASJC Scopus subject areas

  • Surgery
  • Oncology

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The impact of extrahepatic disease among patients undergoing liver-directed therapy for neuroendocrine liver metastasis. / Ejaz, Aslam; Reames, Brad 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, Brad 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, Brad 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

Y1 - 2017/12/1

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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