Abstract
BackgroundLiver 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.MethodsData 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.ResultsInformation 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.ConclusionOur 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.
Highlights
Pancreatic neuroendocrine tumors (PNETs) are a heterogeneous group of neoplasms representing approximately 1% of all pancreatic cancers by incidence and 10% of pancreatic cancers by prevalence [1]
A recent systematic review and meta-analysis showed that palliative resection of primary PNETs in patients with unresectable metastatic liver disease can increase overall survival time (OS), but there was a bias toward patients with better performance status, less advanced disease, or a tumor located in the body or tail of the pancreas [4]
From univariate and multivariate analyses, we found that age over 65 years (HR: 1.493, 95% confidence intervals (CIs): 1.137–1.962), poorly differentiated or undifferentiated tumors (HR: 4.102, 95% CI: 2.942-5.721; Hazard ratios (HRs): 3.338, 95% CI: 2.043–5.455, respectively) and primary tumor resection (HR: 3.771, 95% CI: 2.702–5.263) were independent risk factors related to overall survival time (Table 3)
Summary
Pancreatic neuroendocrine tumors (PNETs) are a heterogeneous group of neoplasms representing approximately 1% of all pancreatic cancers by incidence and 10% of pancreatic cancers by prevalence [1]. For patients with limited liver metastases, surgical resection of both the primary tumor and hepatic disease in a staged or synchronous fashion is recommended. The role and benefit of primary site resection (PTR) in patients with unresectable liver metastases are still controversial. A recent systematic review and meta-analysis showed that palliative resection of primary PNETs in patients with unresectable metastatic liver disease can increase overall survival time (OS), but there was a bias toward patients with better performance status, less advanced disease, or a tumor located in the body or tail of the pancreas [4]. The benefit of primary tumor resection (PTR) in the setting of PNET patients with liver metastases is still controversial in several guidelines
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