Surgical liver debulking and bland embolization for controlling liver metastases in patients with neuroendocrine tumors: A comparative effectiveness analysis.

IF 3.2 2区医学 Q1 SURGERY

Surgery Pub Date : 2026-09-02 DOI:10.1016/j.surg.2026.110594

Patricia G Lu, Joseph Tobias, Daniel Appelbaum, Nicholas Feinberg, Kelvin Memeh, Abdul Khan, Divya Kumari, Mikin Patel, Osman Ahmed, J Michael Millis, Chih-Yi Andy Liao, Xavier M Keutgen

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引用次数: 0

Abstract

Background: Surgical liver debulking and bland embolization (transarterial embolization) are commonly used to control progression of neuroendocrine tumor liver metastases. We sought to determine what sequence of surgical debulking and transarterial embolization provided longer disease control.

Methods: We conducted a retrospective single-center cohort study to create a comparative effectiveness analysis model of surgical debulking and transarterial embolization. Inverse probability of treatment weighting was estimated from primary tumor site, Ki-67, liver tumor volume, and extrahepatic metastases to balance treatment groups. Weighted Kaplan-Meier analyses were used to estimate median progression-free survival.

Results: Among 78 patients with neuroendocrine tumor liver metastases (34 small bowel, 29 pancreas, and 15 other), 24 (31%) underwent surgical debulking only, 23 (30%) surgery followed by transarterial embolization, 26 (33%) transarterial embolization only, and 5 (6%) transarterial embolization followed by surgery. Compared with patients who underwent surgery, transarterial embolization-only patients were more likely to have Ki-67 >20% (26.9% vs 9.6%, P = .03) and greater liver tumor burden (median tumor volume, 231 mL versus 150 mL, P = .04). After inverse probability of treatment weighting, covariate balance improved substantially. Weighted median progression-free survival was 13 months for surgery only or surgery first (95% confidence interval, 12-19) versus 9 months for embolization only or embolization first (95% confidence interval, 5-30, P = .003). Serotonin levels decreased significantly after surgery (1,170 to 434 ng/mL, P = .027) but not after embolization (1,873-1,445 ng/mL, P = .31).

Conclusion: Neuroendocrine tumor liver metastases patients who were treated with surgical liver debulking first had longer progression-free survival. Surgery should be considered first line in appropriately selected patients, with transarterial embolization reserved for recurrent or unresectable disease.

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神经内分泌肿瘤患者肝切除和温和栓塞控制肝转移的比较效果分析。

背景：手术肝减积和温和栓塞（经动脉栓塞）是控制神经内分泌肿瘤肝转移进展的常用方法。我们试图确定手术减压和经动脉栓塞的顺序可以提供更长时间的疾病控制。方法：我们进行了一项回顾性单中心队列研究，以建立手术减压和经动脉栓塞的比较效果分析模型。根据原发肿瘤部位、Ki-67、肝肿瘤体积和肝外转移估计治疗加权的逆概率，以平衡治疗组。加权Kaplan-Meier分析用于估计中位无进展生存期。结果：78例神经内分泌肿瘤肝转移患者（小肠34例，胰腺29例，其他15例）中，仅行手术减容24例（31%），手术后经动脉栓塞23例（30%），单纯经动脉栓塞26例（33%），经动脉栓塞后手术5例（6%）。与接受手术的患者相比，仅经动脉栓塞的患者更有可能有20%的Ki-67 > (26.9% vs 9.6%, P = 0.03)和更大的肝脏肿瘤负担（中位肿瘤体积，231 mL vs 150 mL, P = 0.04）。处理加权逆概率后，协变量平衡显著改善。仅手术或先手术的加权中位无进展生存期为13个月（95%可信区间，12-19），而仅栓塞或先栓塞的加权中位无进展生存期为9个月（95%可信区间，5-30,P = 0.003）。手术后血清素水平显著下降（1170 ~ 434 ng/mL, P = 0.027），栓塞后无显著下降（1873 ~ 1445 ng/mL, P = 0.31）。结论：神经内分泌肿瘤肝转移患者先行手术减肝治疗有较长的无进展生存期。在适当选择的患者中，应首先考虑手术，经动脉栓塞保留用于复发或不可切除的疾病。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.