Liver transplantation for hepatic metastases of neuroendocrine pancreatic tumors: A survival-based analysis

Zoltan Máthé, Evangelos Tagkalos, Andreas Paul, Ernesto P. Molmenti, László Kóbori, Ioannis Fouzas, Susanne Beckebaum, Georgios C. Sotiropoulos

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Abstract

Background: Liver transplantation (LT) has been accepted as a treatment in selected cases of neuroendocrine tumors (NETs) with hepatic metastases. Patients and methods: A systematic review of the literature was conducted to evaluate long-term patient survival in the instances of LT for pancreatic NET. Univariate and multivariate regression analyses and survival analysis were performed. Results: Fifty-three clinical studies were screened. Data from 20 studies encompassing 89 transplanted patients were included in the study. Most primary tumors were endocrine pancreatic tumors (n=69), with gastrinomas representing the most frequent diagnosis (n=21). There were 61 functioning pancreatic NET. Simultaneous LT and pancreatic NET resections were performed in 45 instances. Cumulative 1-, 3-, and 5-year survival was 71%, 55%, and 44%, respectively, with a calculated mean survival of 54.45±6.31 months. Vasoactive intestinal peptide (VIPomas) had the best overall survival. Recurrence-free survival at 1, 3, and 5 years was 84%, 47%, and 47%, respectively. Recipient age more than or equal to 55 years (P=0.0242) and simultaneous LT-pancreatic resection (P=0.0132) were found to be significant predictors of worse survival by both univariate and multivariate Cox proportional hazard analyses. A scoring system was developed, with prognostic points assigned as follows: age more than or equal to 55 years:age less than 55years=1:0 points and simultaneous LT-pancreatic resection:LT alone=1:0 points. This stratification delineated three separate population samples corresponding to patients with scores of 0, 1, and 2, respectively. The calculated 5-year survival for scores 0, 1, and 2 was 61%, 40%, and 0%, respectively (P=0.0023). Conclusions: Despite the limitations of this retrospective analysis, good results can be achieved even for pancreatic NET primaries if the above-proposed scoring system is applied.

Original languageEnglish
Pages (from-to)575-582
Number of pages8
JournalTransplantation
Volume91
Issue number5
DOIs
Publication statusPublished - Mar 15 2011

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Keywords

  • Extended indications
  • Liver metastases
  • Liver transplantation
  • NET
  • Neuroendocrine tumors
  • Pancreatic malignancy
  • Scoring systems

ASJC Scopus subject areas

  • Transplantation

Cite this

Máthé, Z., Tagkalos, E., Paul, A., Molmenti, E. P., Kóbori, L., Fouzas, I., Beckebaum, S., & Sotiropoulos, G. C. (2011). Liver transplantation for hepatic metastases of neuroendocrine pancreatic tumors: A survival-based analysis. Transplantation, 91(5), 575-582. https://doi.org/10.1097/TP.0b013e3182081312