Surgical management of primary hepatic neuroendocrine tumors: A 20-year population-based analysis

Primary hepatic neuroendocrine tumors (PHNETs) are rare neoplasms with limited population-level data to guide treatment. We evaluated clinical, pathologic, and treatment factors associated with surgical intervention and survival using a contemporary national cohort.

Patients diagnosed with PHNETs from 2000 to 2021 were identified within the Surveillance, Epidemiology, and End Results (SEER) database. Demographic, tumor, and treatment characteristics were analyzed. Multivariable logistic regression identified predictors of surgical resection. Kaplan-Meier and Cox models evaluated overall survival (OS) and cause-specific survival (CSS).

A total of 669 patients met inclusion criteria. Surgical resection was performed in 16.4 % of cases. Compared with localized disease, regional disease was associated with significantly lower odds of surgery (OR 0.25, 95 % CI: 0.14-0.45). Ten-year OS was 21.8 % for localized, 12.5 % for regional, and 4.8 % for distant disease (p < 0.001). Well differentiated tumors were associated with superior 5- and 10-year OS and CSS compared to poorly differentiated tumors (p < 0.001). Among patients with localized or regional disease, surgical resection was associated with a 10-year OS of 44.9 % versus 9.2 % without surgery (p < 0.001). On multivariable analysis, poorly differentiated histology (HR 2.69, 95 % CI: 1.93-3.77) and larger tumor size (HR 1.01, 95 % CI: 1.00-1.01) were associated with increased mortality, while surgical resection remained protective (HR 0.23, 95 % CI: 0.15-0.37).

Surgical resection is associated with significantly improved survival in patients with localized or regional PHNETs. Tumor grade, stage, and size remain key prognostic factors in this rare malignancy.