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31.10.2024 | Endocrine Tumors

A Novel Liver Metastasis Score for Patients Undergoing Surgical Resection of Gastroenteropancreatic Neuroendocrine Tumors: A Multi-institutional Study

verfasst von: Qi-Xuan Zheng, MD, Jia-Hao Xu, MD, Fa-Ji Yang, MD, Zhi-Peng Liu, MD, Ming-Da Wang, MD, Yi-Jie Hao, MD, Chao Li, MD, Zhe-Yu Niu, MD, Xin-Fei Xu, MD, Heng-Jun Gao, MD, Yi-Fan Li, MD, Jin-Bo Gong, MD, Zhong Chen, MD, Timothy M. Pawlik, MD, MPH, PhD, FACS, Feng Shen, MD, Jun Lu, MD, Tian Yang, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 2/2025

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Abstract

Background

Liver metastasis impacts survival in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs); however, current guidelines lack consensus on post-resection surveillance and adjuvant therapy. A comprehensive risk stratification tool is needed to guide personalized management.

Objective

We aimed to develop and validate a predictive model for liver metastasis risk after surgical resection of GEP-NETs that incorporates pathological factors and adjuvant therapy.

Methods

Patients with GEP-NETs who underwent surgical resection with curative intent at three major Chinese hospitals (2010–2022) were identified. Univariable and multivariable Cox regression analysis identified independent risk factors of liver metastasis. The liver metastasis score (LMS) was developed using weighted risk factors and validated by tenfold cross-validation.

Results

Among the 724 patients included in the analytic cohort, liver metastasis occurred in 66 patients (9.1%) at a median of 36 months; patients with liver metastasis had a worse 5-year overall survival (no liver metastasis 63.6% vs. liver metastasis 95.8%; p < 0.001). Independent predictors were Ki-67 index (hazard ratio [HR] 10.36 for Ki-67 3–20%, HR 18.30 for Ki-67 >20%, vs. <3%), vascular invasion (HR 5.03), lymph node metastases (HR 2.24), and lack of adjuvant therapy (HR 3.03). The LMS demonstrated excellent discrimination (C-index 0.888) and stratified patients into low, intermediate, and high-risk relative to 5-year risk of liver metastasis: 2.9%, 20.8%, and 49.7%, respectively (p < 0.001).

Conclusions

The novel LMS effectively predicted the risk of liver metastasis after surgical resection of GEP-NETs. This validated model can help guide personalized surveillance and adjuvant treatment strategies, potentially improving outcomes for high-risk patients.
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Metadaten
Titel
A Novel Liver Metastasis Score for Patients Undergoing Surgical Resection of Gastroenteropancreatic Neuroendocrine Tumors: A Multi-institutional Study
verfasst von
Qi-Xuan Zheng, MD
Jia-Hao Xu, MD
Fa-Ji Yang, MD
Zhi-Peng Liu, MD
Ming-Da Wang, MD
Yi-Jie Hao, MD
Chao Li, MD
Zhe-Yu Niu, MD
Xin-Fei Xu, MD
Heng-Jun Gao, MD
Yi-Fan Li, MD
Jin-Bo Gong, MD
Zhong Chen, MD
Timothy M. Pawlik, MD, MPH, PhD, FACS
Feng Shen, MD
Jun Lu, MD
Tian Yang, MD
Publikationsdatum
31.10.2024
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 2/2025
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-16389-0

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