Prognostic Factors In Patients with GastroenteropancreaticNeuroendocrine Neoplasms and Hepatic Metastases

Context Hepatic metastases represent the most relevant prognostic factor in gastroenteropancreatic neuroendocrine tumors and are associated with significantly reduced survival. Objective The aim of this single-institution retrospective series was to evaluate overall survival and progression-free survival from the diagnosis of liver metastases. Patients Among 230 consecutive patients diagnosed with gastroenteropancreatic neuroendocrine tumors, between 1995 and 2013, 93 had hepatic metastases: in 48 the primary tumor was pancreatic, in 45 gastrointestinal. Results Median overall survival was 96 months (95% CI, 48-168), 67% of the patients were progressionfree at 5 years. Eleven patients underwent radical surgery, 49 had non-radical resection and medical therapy, 9 had partial resection with peptide receptor radionuclide therapy, 7 had medical treatment with radionuclide therapy; the remaining 17 patients received medical treatment only. Overall, 13 patients (14%) achieved complete remission, 22 (25%) partial remission, 25 (27%) disease stabilization, and 33 (35%) disease progression. The best overall survival (100% at 10 years) was observed in patients with radical resection. Age at diagnosis (p<0.005), low histological grade (p<0.0001), type of treatment (p<0.001), isolated liver involvement (p<0.001) and early chromogranin A decrease after treatment (p<0.0001) were positively associated with OS. At multivariate analysis, type of treatment (p=0.0029), low histological grade (p<0.0001) and early post-treatment chromogranin A decrease (p=0.0078), retained statistical significance, resulting independent predictors of overall survival. No specific factors were associated with progression-free surviva. Conclusions Our data has clearly defined the prognostic factors in a cohort of 93 patients with gastroenteropancreatic neuroendocrine tumors with liver metastasis.