Surgery versus intra-arterial therapy for neuroendocrine liver metastasis: A multicenter international analysis

Skye Mayo, Mechteld C. De Jong, Mark Bloomston, Carlo Pulitano, Bryan M. Clary, Srinevas K. Reddy, T. Clark Gamblin, Scott A. Celinski, David A. Kooby, Charles A. Staley, Jayme B. Stokes, Carrie K. Chu, David Arrese, Alessandro Ferrero, Richard D. Schulick, Michael A. Choti, Jean Francois H Geschwind, Jennifer Strub, Todd W. Bauer, Reid B. AdamsLuca Aldrighetti, Gilles Mentha, Lorenzo Capussotti, Timothy M. Pawlik

Research output: Contribution to journalArticle

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Abstract

Background: Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to examine the relative efficacy of surgical management versus intra-arterial therapy (IAT) for NELM and determine factors predictive of survival. Methods: A total of 753 patients who had surgery (n = 339) or IAT (n = 414) for NELM from 1985 to 2010 were identified from nine hepatobiliary centers. Clinicopathologic data were assessed with regression modeling and propensity score matching. Results: Most patients had a pancreatic (32%) or a small bowel (27%) primary tumor; 47% had a hormonally active tumor. There were statistically significant differences in characteristics between surgery versus IAT groups (hormonally active tumors: 28 vs. 48%; hepatic tumor burden >25%: 52% vs. 76%) (all P <0.001). Among surgical patients, most underwent hepatic resection alone without ablation (78%). The median number of IAT treatments was 1 (range, 1-4). Median and 5-year survival of patients treated with surgery was 123 months and 74% vs. 34 months and 30% for IAT (P <0.001). In the propensity-adjusted multivariate Cox model, asymptomatic disease (hazard ratio 2.6) was strongly associated with worse outcome (P = 0.001). Although surgical management provided a survival benefit over IAT among symptomatic patients with >25% hepatic tumor involvement, there was no difference in long-term outcome after surgery versus IAT among asymptomatic patients (P = 0.78). Conclusions: Asymptomatic patients with a large (>25%) burden of liver disease benefited least from surgical management and IAT may be a more appropriate treatment strategy. Surgical management of NELM should be reserved for patients with low-volume disease or for those patients with symptomatic high-volume disease.

Original languageEnglish (US)
Pages (from-to)3657-3665
Number of pages9
JournalAnnals of Surgical Oncology
Volume18
Issue number13
DOIs
StatePublished - Dec 2011
Externally publishedYes

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Neoplasm Metastasis
Liver
Therapeutics
Neoplasms
Propensity Score
Group Psychotherapy
Tumor Burden
Liver Diseases
Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Surgery versus intra-arterial therapy for neuroendocrine liver metastasis : A multicenter international analysis. / Mayo, Skye; De Jong, Mechteld C.; Bloomston, Mark; Pulitano, Carlo; Clary, Bryan M.; Reddy, Srinevas K.; Clark Gamblin, T.; Celinski, Scott A.; Kooby, David A.; Staley, Charles A.; Stokes, Jayme B.; Chu, Carrie K.; Arrese, David; Ferrero, Alessandro; Schulick, Richard D.; Choti, Michael A.; Geschwind, Jean Francois H; Strub, Jennifer; Bauer, Todd W.; Adams, Reid B.; Aldrighetti, Luca; Mentha, Gilles; Capussotti, Lorenzo; Pawlik, Timothy M.

In: Annals of Surgical Oncology, Vol. 18, No. 13, 12.2011, p. 3657-3665.

Research output: Contribution to journalArticle

Mayo, S, De Jong, MC, Bloomston, M, Pulitano, C, Clary, BM, Reddy, SK, Clark Gamblin, T, Celinski, SA, Kooby, DA, Staley, CA, Stokes, JB, Chu, CK, Arrese, D, Ferrero, A, Schulick, RD, Choti, MA, Geschwind, JFH, Strub, J, Bauer, TW, Adams, RB, Aldrighetti, L, Mentha, G, Capussotti, L & Pawlik, TM 2011, 'Surgery versus intra-arterial therapy for neuroendocrine liver metastasis: A multicenter international analysis', Annals of Surgical Oncology, vol. 18, no. 13, pp. 3657-3665. https://doi.org/10.1245/s10434-011-1832-y
Mayo, Skye ; De Jong, Mechteld C. ; Bloomston, Mark ; Pulitano, Carlo ; Clary, Bryan M. ; Reddy, Srinevas K. ; Clark Gamblin, T. ; Celinski, Scott A. ; Kooby, David A. ; Staley, Charles A. ; Stokes, Jayme B. ; Chu, Carrie K. ; Arrese, David ; Ferrero, Alessandro ; Schulick, Richard D. ; Choti, Michael A. ; Geschwind, Jean Francois H ; Strub, Jennifer ; Bauer, Todd W. ; Adams, Reid B. ; Aldrighetti, Luca ; Mentha, Gilles ; Capussotti, Lorenzo ; Pawlik, Timothy M. / Surgery versus intra-arterial therapy for neuroendocrine liver metastasis : A multicenter international analysis. In: Annals of Surgical Oncology. 2011 ; Vol. 18, No. 13. pp. 3657-3665.
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abstract = "Background: Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to examine the relative efficacy of surgical management versus intra-arterial therapy (IAT) for NELM and determine factors predictive of survival. Methods: A total of 753 patients who had surgery (n = 339) or IAT (n = 414) for NELM from 1985 to 2010 were identified from nine hepatobiliary centers. Clinicopathologic data were assessed with regression modeling and propensity score matching. Results: Most patients had a pancreatic (32{\%}) or a small bowel (27{\%}) primary tumor; 47{\%} had a hormonally active tumor. There were statistically significant differences in characteristics between surgery versus IAT groups (hormonally active tumors: 28 vs. 48{\%}; hepatic tumor burden >25{\%}: 52{\%} vs. 76{\%}) (all P <0.001). Among surgical patients, most underwent hepatic resection alone without ablation (78{\%}). The median number of IAT treatments was 1 (range, 1-4). Median and 5-year survival of patients treated with surgery was 123 months and 74{\%} vs. 34 months and 30{\%} for IAT (P <0.001). In the propensity-adjusted multivariate Cox model, asymptomatic disease (hazard ratio 2.6) was strongly associated with worse outcome (P = 0.001). Although surgical management provided a survival benefit over IAT among symptomatic patients with >25{\%} hepatic tumor involvement, there was no difference in long-term outcome after surgery versus IAT among asymptomatic patients (P = 0.78). Conclusions: Asymptomatic patients with a large (>25{\%}) burden of liver disease benefited least from surgical management and IAT may be a more appropriate treatment strategy. Surgical management of NELM should be reserved for patients with low-volume disease or for those patients with symptomatic high-volume disease.",
author = "Skye Mayo and {De Jong}, {Mechteld C.} and Mark Bloomston and Carlo Pulitano and Clary, {Bryan M.} and Reddy, {Srinevas K.} and {Clark Gamblin}, T. and Celinski, {Scott A.} and Kooby, {David A.} and Staley, {Charles A.} and Stokes, {Jayme B.} and Chu, {Carrie K.} and David Arrese and Alessandro Ferrero and Schulick, {Richard D.} and Choti, {Michael A.} and Geschwind, {Jean Francois H} and Jennifer Strub and Bauer, {Todd W.} and Adams, {Reid B.} and Luca Aldrighetti and Gilles Mentha and Lorenzo Capussotti and Pawlik, {Timothy M.}",
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T1 - Surgery versus intra-arterial therapy for neuroendocrine liver metastasis

T2 - A multicenter international analysis

AU - Mayo, Skye

AU - De Jong, Mechteld C.

AU - Bloomston, Mark

AU - Pulitano, Carlo

AU - Clary, Bryan M.

AU - Reddy, Srinevas K.

AU - Clark Gamblin, T.

AU - Celinski, Scott A.

AU - Kooby, David A.

AU - Staley, Charles A.

AU - Stokes, Jayme B.

AU - Chu, Carrie K.

AU - Arrese, David

AU - Ferrero, Alessandro

AU - Schulick, Richard D.

AU - Choti, Michael A.

AU - Geschwind, Jean Francois H

AU - Strub, Jennifer

AU - Bauer, Todd W.

AU - Adams, Reid B.

AU - Aldrighetti, Luca

AU - Mentha, Gilles

AU - Capussotti, Lorenzo

AU - Pawlik, Timothy M.

PY - 2011/12

Y1 - 2011/12

N2 - Background: Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to examine the relative efficacy of surgical management versus intra-arterial therapy (IAT) for NELM and determine factors predictive of survival. Methods: A total of 753 patients who had surgery (n = 339) or IAT (n = 414) for NELM from 1985 to 2010 were identified from nine hepatobiliary centers. Clinicopathologic data were assessed with regression modeling and propensity score matching. Results: Most patients had a pancreatic (32%) or a small bowel (27%) primary tumor; 47% had a hormonally active tumor. There were statistically significant differences in characteristics between surgery versus IAT groups (hormonally active tumors: 28 vs. 48%; hepatic tumor burden >25%: 52% vs. 76%) (all P <0.001). Among surgical patients, most underwent hepatic resection alone without ablation (78%). The median number of IAT treatments was 1 (range, 1-4). Median and 5-year survival of patients treated with surgery was 123 months and 74% vs. 34 months and 30% for IAT (P <0.001). In the propensity-adjusted multivariate Cox model, asymptomatic disease (hazard ratio 2.6) was strongly associated with worse outcome (P = 0.001). Although surgical management provided a survival benefit over IAT among symptomatic patients with >25% hepatic tumor involvement, there was no difference in long-term outcome after surgery versus IAT among asymptomatic patients (P = 0.78). Conclusions: Asymptomatic patients with a large (>25%) burden of liver disease benefited least from surgical management and IAT may be a more appropriate treatment strategy. Surgical management of NELM should be reserved for patients with low-volume disease or for those patients with symptomatic high-volume disease.

AB - Background: Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to examine the relative efficacy of surgical management versus intra-arterial therapy (IAT) for NELM and determine factors predictive of survival. Methods: A total of 753 patients who had surgery (n = 339) or IAT (n = 414) for NELM from 1985 to 2010 were identified from nine hepatobiliary centers. Clinicopathologic data were assessed with regression modeling and propensity score matching. Results: Most patients had a pancreatic (32%) or a small bowel (27%) primary tumor; 47% had a hormonally active tumor. There were statistically significant differences in characteristics between surgery versus IAT groups (hormonally active tumors: 28 vs. 48%; hepatic tumor burden >25%: 52% vs. 76%) (all P <0.001). Among surgical patients, most underwent hepatic resection alone without ablation (78%). The median number of IAT treatments was 1 (range, 1-4). Median and 5-year survival of patients treated with surgery was 123 months and 74% vs. 34 months and 30% for IAT (P <0.001). In the propensity-adjusted multivariate Cox model, asymptomatic disease (hazard ratio 2.6) was strongly associated with worse outcome (P = 0.001). Although surgical management provided a survival benefit over IAT among symptomatic patients with >25% hepatic tumor involvement, there was no difference in long-term outcome after surgery versus IAT among asymptomatic patients (P = 0.78). Conclusions: Asymptomatic patients with a large (>25%) burden of liver disease benefited least from surgical management and IAT may be a more appropriate treatment strategy. Surgical management of NELM should be reserved for patients with low-volume disease or for those patients with symptomatic high-volume disease.

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