Early recurrence of well-differentiated (G1) neuroendocrine liver metastasis after curative-intent surgery: Risk factors and outcome

JX Xiang, XF Zhang, M Weiss, L Aldrighetti, GA Poultsides, TW Bauer, RC Fields, SK Maithel, HP Marques, TM Pawlik

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Abstract

Background: The objective of the current study was to identify the risk of early vs late recurrence of well-differentiated (G1) neuroendocrine liver metastasis (NELM) after curative-intent resection. Methods: Patients who underwent curative-intent resection for well-differentiated NELM were identified from a multi-institutional database. Clinicopathological details, as well as the long-term overall (OS) and recurrence free survival (RFS) were obtained and compared. The optimal cutoff value to differentiate early and late recurrence was determined to be 1 year based on trend curve analysis. Results: Among the 548 patients undergoing curative resection for NELM, 162 patients had a well-differentiated NELM. After a median follow-up of 69 months, 59 (36.4%) patients had tumor recurrence; 23 (39.0%) patients recurred within 1 year (early recurrence) after surgery, while 36 (61.0%) recurred after 1 year (late recurrence). Early recurrence was associated with worse outcome vs late recurrence (5-year OS, 72.4% vs 92.0%; P = 0.020) and no recurrence (5-year OS, 72.4% vs 100.0%; P <0.001). In addition, postrecurrence survival was worse within 36 months after recurrence among patients who recurred early compared with patients who recurred late (survival after recurrence at 36 months: early recurrence, 71.6% vs late recurrence, 91.4%; P = 0.047), although survival was comparable at 60 months (early recurrence, 71.6% vs late recurrence, 70.0%; P = 0.304). On multivariable analysis, nonfunctional neuroendocrine tumors (hazard ratio [HR], 4.4; 95% confidence interval [CI], 1.2-16.7; P = 0.029) and lymph node metastasis (HR, 3.6; 95% CI, 1.1-11.1; P = 0.028) were independent risk factors for early recurrence, whereas lymph node metastasis (HR, 3.0; 95% CI, 1.2-7.8; P = 0.020) and R1 resection (HR, 3.9; 95% CI, 1.4-10.5; P = 0.008) were independently associated with late recurrence. Conclusions: Roughly, one-third of patients with well-differentiated NELM experienced a recurrence following curative-intent surgery. Among patients who recurred, two out of five patients recurred within 1 year after surgery. Early recurrence of well-differentiated NELM was associated with the hormone functional status and lymph node metastasis. © 2018 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)1096-1104
Number of pages9
JournalJournal of Surgical Oncology
Volume118
Issue number7
DOIs
Publication statusPublished - 2018

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    Xiang, JX., Zhang, XF., Weiss, M., Aldrighetti, L., Poultsides, GA., Bauer, TW., Fields, RC., Maithel, SK., Marques, HP., & Pawlik, TM. (2018). Early recurrence of well-differentiated (G1) neuroendocrine liver metastasis after curative-intent surgery: Risk factors and outcome. Journal of Surgical Oncology, 118(7), 1096-1104. https://doi.org/10.1002/jso.25246