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Liver transplantation for metastatic neuroendocrine tumors: Outcomes and prognostic variables
Author(s) -
Sher Linda S.,
Levi David M.,
Wecsler Julie S.,
Lo Mary,
Petrovic Lydia M.,
Groshen Susan,
Ji Lingyun,
Uso Teresa Diago,
Tector A. Joseph,
Hamilton Ann S.,
Marsh J. Wallis,
Schwartz Myron E.
Publication year - 2015
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23973
Subject(s) - medicine , neuroendocrine tumors , liver transplantation , transplantation , oncology
Background Patient selection for liver transplantation for metastatic neuroendocrine tumors remains a topic of debate. There is no established MELD exception, making it difficult to obtain donor organs. Methods A multicenter database was created assessing outcomes for liver and multivisceral transplantation for metastatic neuroendocrine tumors and identifying prognostic factors for survival. Demographic, transplant, primary tumor site and management, pathology, recurrent disease and survival data were collected and analyzed. Survival probabilities were calculated using the Kaplan–Meier method. Results Analysis included 85 patients who underwent liver transplantation November 1988–January 2012 at 28 centers. One, three, and five‐year patient survival rates were 83%, 60%, and 52%, respectively; 40 of 85 patients died, with 20 of 40 deaths due to recurrent disease. In univariate analyses, the following were predictors of poor prognosis: large vessel invasion ( P < 0.001), extent of extrahepatic resection at liver transplant ( P = 0.007), and tumor differentiation ( P = 0.003). In multivariable analysis, predictors of poor overall survival included large vessel invasion ( P = 0.001), and extent of extrahepatic resection at liver transplant ( P = 0.015). Conclusion In the absence of poor prognostic factors, metastatic neuroendocrine tumor is an acceptable indication for liver transplantation. Identification of favorable prognostic factors should allow assignment of a MELD exception similar to hepatocellular carcinoma. J. Surg. Oncol. 2015 111:125–132 . © 2015 Wiley Periodicals, Inc.