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)
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.
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