Hepatic micrometastases are associated with poor prognosis in patients with liver metastases from neuroendocrine tumors of the digestive tract

Published on Sep 1, 2018in Human Pathology3.466
· DOI :10.1016/J.HUMPATH.2018.05.006
William E. Gibson2
Estimated H-index: 2
(VUMC: Vanderbilt University Medical Center),
Raul S. Gonzalez18
Estimated H-index: 18
(URMC: University of Rochester Medical Center)
+ 2 AuthorsChanjuan Shi42
Estimated H-index: 42
(VUMC: Vanderbilt University Medical Center)
Sources
Abstract
Summary Pathologic examination of hepatic metastasectomies from patients with metastatic small intestinal or pancreatic neuroendocrine tumor frequently reveals micrometastases undetectable by radiologic or macroscopic gross examination. This finding raises the possibility that undetectable micrometastases remain in these patients after metastasectomy. Here we examined liver resections for micrometastases and assessed their impact on prognosis. Hepatic metastasectomies from 65 patients with neuroendocrine tumor of the small intestine (N = 43) or pancreas (N = 22) were reviewed for the presence of micrometastases, which were defined as microscopic tumor foci ≤1 mm in greatest dimension. Medical records were also reviewed for patient demographics, clinical history, and follow-up data. Micrometastasis was identified in 36 (55%) of 65 hepatic resection specimens. More hepatic micrometastases were seen in small intestinal cases than in pancreatic cases (29/43, 67%, versus 7/22, 32%; P P  = .03) and after accounting for confounding variables in stratified Cox regression (HR 4.82; 95% CI 1.06 21.79; P = .04). In conclusion, hepatic micrometastases are common in patients with metastatic small intestinal or pancreatic neuroendocrine tumor and are independently associated with poor prognosis. These data suggest that surgical resection of hepatic metastases is likely not curative in these patients.
📖 Papers frequently viewed together
9 Authors (Masao Nanko, ..., Masamichi Hara)
References23
Newest
#1Mongkon Charoenpitakchai (VUMC: Vanderbilt University Medical Center)H-Index: 1
#2Eric LiuH-Index: 11
Last. Chanjuan Shi (VUMC: Vanderbilt University Medical Center)H-Index: 42
view all 9 authors...
We examined somatostatin receptor type 2A (SSTR2A) expression in primary and metastatic small intestinal neuroendocrine tumors (SI-NETs). We retrieved 156 liver metastases from 26 patients (10 males, 16 females) who had two or more liver lesions resected. A representative formalin-fixed paraffin-embedded section of tumor tissue from each liver metastasis and from the primary tumor, when available, were immunohistochemically stained for SSTR2A. SSTR2A expression was evaluated by the Her2/neu-scor...
Source
Mesenteric tumor deposits (MTDs) are not included in the American Joint Committee on Cancer (AJCC) staging system for midgut small intestinal neuroendocrine tumors (NETs). We examined the prognostic significance of MTDs associated with midgut NETs. Hematoxylin and eosin slides from 132 resected jejunal/ileal NETs were reviewed for AJCC tumor stage, lymph node (LN) metastasis, MTDs, and hepatic metastases. MTDs were defined as discrete irregular mesenteric tumor nodules discontinuous from the pri...
Source
#1Antonio ViudezH-Index: 16
#2A. De Jesus-Acosta (Johns Hopkins University)H-Index: 2
Last. Natalia RamirezH-Index: 15
view all 6 authors...
Pancreatic neuroendocrine tumours (PanNETs) are considered a relatively unusual oncologic entity. Due to its relative good prognosis, surgery remains the goal standard therapy not only in localized disease but also in the setting of locally or metastatic disease. Most of the patients are diagnosed in metastatic scenario, where multidisciplinary approach based on surgery, chemotherapies, liver-directed and/or molecular targeted therapies are commonly used. Owing to a deeper molecular knowledge of...
Source
The goal of this paper is to update a more extensive review and guidelines paper published in 2012 [1] . Gen-erally, any pertinent update pertaining to the diagnosis and staging of individual prima ...
Source
#1Antonio Viudez (Johns Hopkins University)H-Index: 16
#2Filipe L.F. Carvalho (Johns Hopkins University)H-Index: 9
Last. Ana De Jesus-AcostaH-Index: 14
view all 11 authors...
// Antonio Viudez 1, 2 , Filipe L.F. Carvalho 1 , Zahra Maleki 3 , Marianna Zahurak 4 , Daniel Laheru 1 , Alejandro Stark 1 , Nilofer Z. Azad 1 , Christopher L. Wolfgang 1 , Stephen Baylin 1 , James G. Herman 1 , Ana De Jesus-Acosta 1 1 Department of Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medical Institutions, Baltimore, Maryland, USA 2 Department of Medical Oncology, Complejo Hospitalario de Navarra-Instituto de Investigaciones Sanitarias de Navarra-IDI...
Source
Source
#1Heather A. Farley (OHSU: Oregon Health & Science University)H-Index: 2
#2Rodney F. Pommier (OHSU: Oregon Health & Science University)H-Index: 41
Neuroendocrine tumors are rare and slow-growing malignancies that commonly metastasize to the liver, resulting hormonal syndromes and death from liver failure. Surgical consultation and liver debulking are key components in management. Traditional surgical resection guidelines do not apply to these tumors as with other cancers. Surgical resection has shown survival benefit even in the event of an incomplete resection. Ablation may be used as an adjunct to resection or in patients who are not can...
Source
#1Alexandria T. Phan (University of Texas MD Anderson Cancer Center)H-Index: 44
#2Daniel M. Halperin (University of Texas MD Anderson Cancer Center)H-Index: 14
Last. Matthew H. Kulke (Harvard University)H-Index: 81
view all 10 authors...
Summary Background Treatment options for advanced, well-differentiated neuroendocrine tumours (NETs) remain scarce. Pazopanib is an orally bioavailable, small molecule, multitargeted kinase inhibitor that inhibits VEGF receptors 1, 2, and 3. We did a study of the efficacy of pazopanib with depot octreotide in patients with advanced NETs. Methods We did a parallel cohort study of patients with metastatic or locally advanced grade 1–2 carcinoid tumours or pancreatic NETs, by use of a single-group,...
Source
#1Andrea Frilling (ICL: Imperial College London)H-Index: 20
#2Ashley K. CliftH-Index: 14
Patients who have neuroendocrine tumors frequently present with liver metastases. A wide panel of treatment options exists for these patients. Liver resection with curative intent achieves the best long-term results. Highly selected patients may be considered for liver transplantation. Substantial recurrence rates reported after surgical approaches call for neoadjuvant and adjuvant concepts. Liver-directed, locally ablative procedures are recommended for patients with limited, nonresectable tumo...
Source
#1Raul S. Gonzalez (VUMC: Vanderbilt University Medical Center)H-Index: 18
#2Eric Liu (VUMC: Vanderbilt University Medical Center)H-Index: 11
Last. Chanjuan Shi (VUMC: Vanderbilt University Medical Center)H-Index: 42
view all 6 authors...
Should mesenteric tumor deposits be included in staging of well-differentiated small intestine neuroendocrine tumors?
Source
Cited By17
Newest
#1Mikael Kerboeuf (NMBU: Norwegian University of Life Sciences)
#2Erling Olaf Koppang (NMBU: Norwegian University of Life Sciences)H-Index: 25
Last. Lars Moe (NMBU: Norwegian University of Life Sciences)H-Index: 16
view all 7 authors...
BACKGROUND Despite decades of research, the early phases of metastatic development are still not fully understood. Canine osteosarcoma (OS) is a highly aggressive cancer, with a high metastatic rate (> 90%), despite a low overt metastatic prevalence at initial diagnosis ( 50 tumour cells) and TP-3 positive single cells ( 90%) based on commonly expected metastatic rates after amputation (P < 0.0001). There was no statistically significant difference in the number of TP-3 positive single cells in ...
Source
#1J. Kjaer (Uppsala University)H-Index: 1
#2Peter Stålberg (Uppsala University)H-Index: 20
Last. Olov Norlén (Uppsala University)H-Index: 14
view all 7 authors...
BACKGROUND Pancreatic neuroendocrine tumours (Pan-NETs) are rare tumours that often present with or develop liver metastases. The aim of this retrospective study was to evaluate liver surgery and thermal hepatic ablation (THA) of Pan-NET liver metastases and to compare the outcomes with those of a control group. METHOD Patients with Pan-NET treated in Uppsala University Hospital and Sahlgrenska University Hospital from 1995-2018 were included. Patient records were scrutinized for baseline parame...
Source
#1Ivan Damjanov (KU: University of Kansas)H-Index: 58
This review deals with serologic and immunohistochemical tumor markers used in clinical laboratories for the diagnosis of testicular germ cell tumors. Time tested serologic markers such as alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase are routinely used in the work-up of patients with testicular tumors. Professional organizations regulating the practice of medicine in most countries worldwide require that the laboratory values for these serologic reactants be include...
Source
#1Anna Malczewska (Medical University of Silesia)H-Index: 13
#2Kjell Öberg (Uppsala University Hospital)H-Index: 117
Last. Beata Kos-Kudła (Medical University of Silesia)H-Index: 31
view all 3 authors...
Introduction The absence of a reliable, universal biomarker is a significant limitation in neuroendocrine neoplasia (NEN) management. We prospectively evaluated two CgA assays, (NEOLISA, EuroDiagnostica) and (CgA ELISA, Demeditec Diagnostics (DD)) and compared the results to the NETest. Methods NEN cohort (n = 258): pancreatic, n = 67; small intestine, n = 40; appendiceal, n = 10; rectal, n = 45; duodenal, n = 9; gastric, n = 44; lung, n = 43. Image-positive disease (IPD) (n = 123), image & hist...
Source
#1Oddry FolkestadH-Index: 1
#2Hans H. Wasmuth (NTNU: Norwegian University of Science and Technology)H-Index: 11
Last. Reidar Fossmark (NTNU: Norwegian University of Science and Technology)H-Index: 24
view all 6 authors...
Abstract Background and objectives Small intestinal neuroendocrine tumors (SI-NETs) are slow growing but have frequently metastasized at the time of diagnosis. Most patients are operated with either curative intent or with intent to prolong overall survival. In the current study we have examined overall and disease-free survival in patients operated for SI-NETs. Methods All patients with a histological diagnosis of SI-NET at St Olav's hospital in the period 1998–2018 were reviewed retrospectivel...
Source
Small-intestinal neuroendocrine tumors (SI-NETs) are the most prevalent small bowel neoplasms with an increasing frequency. In the multimodal management of SI-NETs, surgery plays a key role, either in curative intent, even if R0 resection is feasible in only 20% of patients due to advanced stage at diagnosis, or palliative intent. Surgeons must be informed about the specific surgical management of SI-NETs according to their hormonal secretion, their usual dissemination at the time of diagnosis a...
Source
#1Florian Bösch (LMU: Ludwig Maximilian University of Munich)H-Index: 9
#2Orlin BelyaevH-Index: 21
Last. Olga Radulova-Mauersberger (LMU: Ludwig Maximilian University of Munich)H-Index: 2
view all 10 authors...
Neuroendocrine neoplasms of the pancreas (pNEN) have an increasing incidence and prevalence. Thus, this entity is of increasing clinical significance. Patients with pNEN become clinically apparent due to different and unspecific symptoms. Some tumours secrete hormones and peptides and become clinically symptomatic. In general, these tumours can metastasise early and even small tumours lead to distant metastases. Nonetheless, primary tumour size and grading are important prognostic factors. On th...
Source
Neuroendocrine tumors of the gastrointestinal tract or pancreas are rare. Their presentation overlaps with other intra-abdominal neoplasms, but can have unique features. The workup involves recognition of unusual clinical features associated with the tumors, imaging, analysis of blood or urine concentrations, and biopsy. Functional imaging takes advantage of the neuroendocrine tumor-specific expression of somatostatin receptors. There are characteristic features supporting the diagnosis on contr...
Source
#1Michael Linecker (UZH: University of Zurich)H-Index: 19
#2Patryk Kambakamba (UZH: University of Zurich)H-Index: 15
Last. Andrea Frilling (ICL: Imperial College London)H-Index: 14
view all 28 authors...
Abstract Background Surgery is the most effective treatment option for neuroendocrine liver metastases (NELM). This study investigated the role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a novel strategy in treatment of NELM. Methods The International ALPPS Registry was reviewed to study patients who underwent ALPPS for NELM. Results From 2010 to 2017, 954 ALPPS procedures from 135 international centers were recorded in the International ALPPS Regis...
Source
#1Johannes Hofland (EUR: Erasmus University Rotterdam)H-Index: 20
#2Gregory Kaltsas (UoA: National and Kapodistrian University of Athens)H-Index: 72
Last. Wouter W. de Herder (EUR: Erasmus University Rotterdam)H-Index: 71
view all 3 authors...
Neuroendocrine neoplasms constitute a diverse group of tumors that derive from the sensory and secretory neuroendocrine cells and predominantly arise within the pulmonary and gastrointestinal tracts. The majority of these neoplasms have a well-differentiated grade and are termed neuroendocrine tumors (NETs). This subgroup is characterized by limited proliferation and patients affected by these tumors carry a good to moderate prognosis. A substantial subset of patients presenting with a NET suffe...
Source
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.