TY - JOUR
T1 - Controversy Over Liver Transplantation or Resection for Neuroendocrine Liver Metastasis
T2 - Tumor Biology Cuts the Deal
AU - Eshmuminov, Dilmurodjon
AU - Studer, Debora J.
AU - Lopez Lopez, Victor
AU - Schneider, Marcel A.
AU - Lerut, Jan
AU - Lo, Mary
AU - Sher, Linda
AU - Musholt, Thomas J.
AU - Lozan, Oana
AU - Bouzakri, Nabila
AU - Sposito, Carlo
AU - Miceli, Rosalba
AU - Barat, Shoma
AU - Morris, David
AU - Oehler, Helga
AU - Schreckenbach, Teresa
AU - Husen, Peri
AU - Rosen, Charles B.
AU - Gores, Gregory J.
AU - Masui, Toshihiko
AU - Cheung, Tan To
AU - Kim-Fuchs, Corina
AU - Perren, Aurel
AU - Dutkowski, Philipp
AU - Petrowsky, Henrik
AU - Thiis-Evensen, Espen
AU - Line, Pål Dag
AU - Grat, Michal
AU - Partelli, Stefano
AU - Falconi, Massimo
AU - Tanno, Lulu
AU - Robles-Campos, Ricardo
AU - Mazzaferro, Vincenzo
AU - Clavien, Pierre Alain
AU - Lehmann, Kuno
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Background: In patients with neuroendocrine liver metastasis (NELM), liver transplantation (LT) is an alternative to liver resection (LR), although the choice of therapy remains controversial. In this multicenter study, we aim to provide novel insight in this dispute. Methods: Following a systematic literature search, 15 large international centers were contacted to provide comprehensive data on their patients after LR or LT for NELM. Survival analyses were performed with the Kaplan-Meier method, while multivariable Cox regression served to identify factors influencing survival after either transplantation or resection. Inverse probability weighting and propensity score matching was used for analyses with balanced and equalized baseline characteristics. Results: Overall, 455 patients were analyzed, including 230 after LR and 225 after LT, with a median follow-up of 97 months [95% confidence interval (CI): 85-110 months]. Multivariable analysis revealed G3 grading as a negative prognostic factor for LR [hazard ratio (HR)=2.22, 95% CI: 1.04-4.77, P=0.040], while G2 grading (HR=2.52, 95% CI: 1.15-5.52, P=0.021) and LT outside Milan criteria (HR=2.40, 95% CI: 1.16-4.92, P=0.018) were negative prognostic factors in transplanted patients. Inverse probability-weighted multivariate analyses revealed a distinct survival benefit after LT. Matched patients presented a median overall survival (OS) of 197 months (95% CI: 143-not reached) and a 73% 5-year OS after LT, and 119 months (95% CI: 74-133 months) and a 52.8% 5-year OS after LR (HR=0.59, 95% CI: 0.3-0.9, P=0.022). However, the survival benefit after LT was lost if patients were transplanted outside Milan criteria. Conclusions: This multicentric study in patients with NELM demonstrates a survival benefit of LT over LR. This benefit depends on adherence to selection criteria, in particular low-grade tumor biology and Milan criteria, and must be balanced against potential risks of LT.
AB - Background: In patients with neuroendocrine liver metastasis (NELM), liver transplantation (LT) is an alternative to liver resection (LR), although the choice of therapy remains controversial. In this multicenter study, we aim to provide novel insight in this dispute. Methods: Following a systematic literature search, 15 large international centers were contacted to provide comprehensive data on their patients after LR or LT for NELM. Survival analyses were performed with the Kaplan-Meier method, while multivariable Cox regression served to identify factors influencing survival after either transplantation or resection. Inverse probability weighting and propensity score matching was used for analyses with balanced and equalized baseline characteristics. Results: Overall, 455 patients were analyzed, including 230 after LR and 225 after LT, with a median follow-up of 97 months [95% confidence interval (CI): 85-110 months]. Multivariable analysis revealed G3 grading as a negative prognostic factor for LR [hazard ratio (HR)=2.22, 95% CI: 1.04-4.77, P=0.040], while G2 grading (HR=2.52, 95% CI: 1.15-5.52, P=0.021) and LT outside Milan criteria (HR=2.40, 95% CI: 1.16-4.92, P=0.018) were negative prognostic factors in transplanted patients. Inverse probability-weighted multivariate analyses revealed a distinct survival benefit after LT. Matched patients presented a median overall survival (OS) of 197 months (95% CI: 143-not reached) and a 73% 5-year OS after LT, and 119 months (95% CI: 74-133 months) and a 52.8% 5-year OS after LR (HR=0.59, 95% CI: 0.3-0.9, P=0.022). However, the survival benefit after LT was lost if patients were transplanted outside Milan criteria. Conclusions: This multicentric study in patients with NELM demonstrates a survival benefit of LT over LR. This benefit depends on adherence to selection criteria, in particular low-grade tumor biology and Milan criteria, and must be balanced against potential risks of LT.
KW - NET
KW - liver metastases
KW - liver resection
KW - liver transplantation
KW - neuroendocrine tumors
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U2 - 10.1097/SLA.0000000000005663
DO - 10.1097/SLA.0000000000005663
M3 - Article
C2 - 35975918
AN - SCOPUS:85152265460
SN - 0003-4932
VL - 277
SP - E1063-E1071
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -