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Published on: January 25, 2015
Liver transplantation in patients with liver metastases from neuroendocrine tumors
Gaya Spolverato1, Fabio Bagante2, Diamantis I Tsilimigras3
1Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
Abstract:
The prevalence of metastatic disease in neuroendocrine tumors (NETs) is very high (60-80%) and cancer-related death among these patients is generally due to metastatic disease. Numerous treatment options for cure and disease control have been investigated for patients with neuroendocrine liver metastases (NELM). Despite the success of liver directed therapy on slowing tumor progression and palliating symptoms, the chance of being cured by liver resection is 40-50% and only roughly 20% of patients have potentially resectable disease. As such, there has been interest in liver transplantation (LT) as a potentially curative option for patients with unresectable disease. Several criteria have been proposed in order to balance long-term outcomes of patients with NELM and the problem of organ shortage including the Milan-NET criteria, the UNOS criteria and the ENETS guidelines. In the most representative studies, recurrence rate after LT has ranged from 30% to 60% with a 5-year OS ranging from 50% to 97%. This large variability is due to the retrospective nature of the studies available, which used different inclusion criteria. As such, outcomes and the prognostic factors associated with LT for NELM warrant further investigation.
Insights
Liver transplantation offers a potentially curative option for neuroendocrine liver metastases (NELM) when surgery is not possible. Outcomes vary significantly, necessitating further research into prognostic factors for this advanced cancer treatment.
Area of Science:
- Oncology
- Hepatology
- Transplantation Surgery
Background:
- Metastatic neuroendocrine tumors (NETs) frequently involve the liver (60-80%), driving cancer-related mortality.
- While liver-directed therapies slow progression, curative options like resection are limited to ~20% of patients.
- Neuroendocrine liver metastases (NELM) present a significant challenge due to high metastatic rates and limited surgical curability.
Purpose of the Study:
- To investigate liver transplantation (LT) as a potentially curative treatment for unresectable neuroendocrine liver metastases (NELM).
- To review existing criteria (Milan-NET, UNOS, ENETS) for patient selection in LT for NELM.
- To analyze outcomes and identify prognostic factors for LT in NELM patients.
Main Methods:
- Review of retrospective studies on liver transplantation for neuroendocrine liver metastases.
- Analysis of proposed selection criteria including Milan-NET, UNOS, and ENETS guidelines.
- Evaluation of recurrence rates and overall survival (OS) post-LT for NELM.
Main Results:
- Recurrence rates after LT for NELM range widely from 30% to 60%.
- Five-year overall survival (OS) post-LT varies significantly, from 50% to 97%.
- Variability in outcomes is attributed to differing inclusion criteria in retrospective studies.
Conclusions:
- Liver transplantation is a viable, potentially curative option for select patients with unresectable NELM.
- Current evidence on LT outcomes for NELM is limited by study heterogeneity and requires further investigation.
- Standardized criteria and further research are crucial to optimize LT selection and outcomes for NELM.
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