Liver Transplantation for Neuroendocrine Tumors in Europe-Results and Trends in Patient Selection: A 213-Case European Liver Transplant Registry Study.

Détails

ID Serval
serval:BIB_3040AF5BD807
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Liver Transplantation for Neuroendocrine Tumors in Europe-Results and Trends in Patient Selection: A 213-Case European Liver Transplant Registry Study.
Périodique
Annals of Surgery
Auteur(s)
Le Treut Y.P., Grégoire E., Klempnauer J., Belghiti J., Jouve E., Lerut J., Castaing D., Soubrane O., Boillot O., Mantion G., Homayounfar K., Bustamante M., Azoulay D., Wolf P., Krawczyk M., Pascher A., Suc B., Chiche L., de Urbina J.O., Mejzlik V., Pascual M., Lodge J.P., Gruttadauria S., Paye F., Pruvot F.R., Thorban S., Foss A., Adam R., For ELITA
Contributeur(s)
For ELITA
ISSN
1528-1140 (Electronic)
ISSN-L
0003-4932
Statut éditorial
Publié
Date de publication
2013
Volume
257
Numéro
5
Pages
807-815
Langue
anglais
Notes
Publication types: JOURNAL ARTICLEPublication Status: ppublish
Résumé
OBJECTIVE:: The purpose of this study was to assess outcomes and indications in a large cohort of patients who underwent liver transplantation (LT) for liver metastases (LM) from neuroendocrine tumors (NET) over a 27-year period. BACKGROUND:: LT for NET remains controversial due to the absence of clear selection criteria and the scarcity and heterogeneity of reported cases. METHODS:: This retrospective multicentric study included 213 patients who underwent LT for NET performed in 35 centers in 11 European countries between 1982 and 2009. One hundred seven patients underwent transplantation before 2000 and 106 after 2000. Mean age at the time of LT was 46 years. Half of the patients presented hormone secretion and 55% had hepatomegaly. Before LT, 83% of patients had undergone surgical treatment of the primary tumor and/or LM and 76% had received chemotherapy. The median interval between diagnosis of LM and LT was 25 months (range, 1-149 months). In addition to LT, 24 patients underwent major resection procedures and 30 patients underwent minor resection procedures. RESULTS:: Three-month postoperative mortality was 10%. At 5 years after LT, overall survival (OS) was 52% and disease-free survival was 30%. At 5 years from diagnosis of LM, OS was 73%. Multivariate analysis identified 3 predictors of poor outcome, that is, major resection in addition to LT, poor tumor differentiation, and hepatomegaly. Since 2000, 5-year OS has increased to 59% in relation with fewer patients presenting poor prognostic factors. Multivariate analysis of the 106 cases treated since 2000 identified the following predictors of poor outcome: hepatomegaly, age more than 45 years, and any amount of resection concurrent with LT. CONCLUSIONS:: LT is an effective treatment of unresectable LM from NET. Patient selection based on the aforementioned predictors can achieve a 5-year OS between 60% and 80%. However, use of overly restrictive criteria may deny LT to some patients who could benefit. Optimal timing for LT in patients with stable versus progressive disease remains unclear.
Pubmed
Web of science
Création de la notice
16/05/2013 16:47
Dernière modification de la notice
20/08/2019 13:15
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