Liver metastases occur in nearly half of NET patients (MNETs) and heavily affect prognosis, with 5-yr. OS around 19–38%. Although it is difficult to show outcome differences for available treatments, due to the long course of disease, surgery for MNETs remains the most effective option in terms of survival and symptom control. Since MNETs frequently present as an oligo-metastatic, liver-limited disease, unresectable in 80% of cases, liver transplantation (LT) has emerged as a potential curative treatment. Nevertheless, experience with LT for MNETs is limited and burdened by highly heterogeneous outcomes and significant recurrence rate, mostly explained by the variability of selection criteria. Several prognostic factors have been identified: extended surgery on primary tumor associated to LT, elderly patients, pancreatic primary (pNET), extensive liver involvement, poorly differentiated tumors, high Ki67 levels and short wait time to LT. A proper patients’ selection based on these data (Milan NET criteria) allows a significant survival advantage over non-transplant strategies, with excellent outcomes in recent series (69–97.2% 5-yr. OS) as opposed to patients undergoing non-surgical treatments (34–50.9%). Evidence indicates LT as the best option for selected patients with MNETs. The use of organs for MNETs is therefore justified.

The place of liver transplantation in the treatment of hepatic metastases from neuroendocrine tumors : Pros and cons / C. Sposito, M. Droz Dit Busset, D. Citterio, M. Bongini, V. Mazzaferro. - In: REVIEWS IN ENDOCRINE & METABOLIC DISORDERS. - ISSN 1389-9155. - 18:4(2017 Dec), pp. 473-483. [10.1007/s11154-017-9439-7]

The place of liver transplantation in the treatment of hepatic metastases from neuroendocrine tumors : Pros and cons

C. Sposito
Primo
;
M. Droz Dit Busset
Secondo
;
D. Citterio;M. Bongini
Penultimo
;
V. Mazzaferro
Ultimo
2017-12

Abstract

Liver metastases occur in nearly half of NET patients (MNETs) and heavily affect prognosis, with 5-yr. OS around 19–38%. Although it is difficult to show outcome differences for available treatments, due to the long course of disease, surgery for MNETs remains the most effective option in terms of survival and symptom control. Since MNETs frequently present as an oligo-metastatic, liver-limited disease, unresectable in 80% of cases, liver transplantation (LT) has emerged as a potential curative treatment. Nevertheless, experience with LT for MNETs is limited and burdened by highly heterogeneous outcomes and significant recurrence rate, mostly explained by the variability of selection criteria. Several prognostic factors have been identified: extended surgery on primary tumor associated to LT, elderly patients, pancreatic primary (pNET), extensive liver involvement, poorly differentiated tumors, high Ki67 levels and short wait time to LT. A proper patients’ selection based on these data (Milan NET criteria) allows a significant survival advantage over non-transplant strategies, with excellent outcomes in recent series (69–97.2% 5-yr. OS) as opposed to patients undergoing non-surgical treatments (34–50.9%). Evidence indicates LT as the best option for selected patients with MNETs. The use of organs for MNETs is therefore justified.
cancer/malignancy/neoplasia; neuroendocrine tumors; metastatic disease; liver disease: malignant; liver transplantation; liver metastases; recipient selection
Settore MED/18 - Chirurgia Generale
gen-2018
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/554070
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