Hepatic micrometastases are associated with poor prognosis in patients with liver metastases from neuroendocrine tumors of the digestive tract
Pathologic examination of hepatic metastasectomies from patients with metastatic small intestinal or pancreatic neuroendocrine tumor frequently reveals micrometastases undetectable by radiologic or macroscopic gross examination. This finding raises the possibility that undetectable micrometastases r...
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| Veröffentlicht in: | Human pathology 2018-09, Vol.79, p.109-115 |
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| creator | Gibson, William E. Gonzalez, Raul S. Cates, Justin M.M. Liu, Eric Shi, Chanjuan |
| description | Pathologic examination of hepatic metastasectomies from patients with metastatic small intestinal or pancreatic neuroendocrine tumor frequently reveals micrometastases undetectable by radiologic or macroscopic gross examination. This finding raises the possibility that undetectable micrometastases remain in these patients after metastasectomy. Here we examined liver resections for micrometastases and assessed their impact on prognosis. Hepatic metastasectomies from 65 patients with neuroendocrine tumor of the small intestine (N = 43) or pancreas (N = 22) were reviewed for the presence of micrometastases, which were defined as microscopic tumor foci ≤1 mm in greatest dimension. Medical records were also reviewed for patient demographics, clinical history, and follow-up data. Micrometastasis was identified in 36 (55%) of 65 hepatic resection specimens. More hepatic micrometastases were seen in small intestinal cases than in pancreatic cases (29/43, 67%, versus 7/22, 32%; P |
| doi_str_mv | 10.1016/j.humpath.2018.05.006 |
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•Hepatic micrometastases are common in liver metastasis from digestive NETs.•Patients with hepatic micrometastases had more liver lesions than those without.•R0 resection was more likely achieved in patients without hepatic micrometastases.•Hepatic micrometastases are associated with poor overall survival.</description><identifier>ISSN: 0046-8177</identifier><identifier>EISSN: 1532-8392</identifier><identifier>DOI: 10.1016/j.humpath.2018.05.006</identifier><identifier>PMID: 29763717</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Liver ; Liver metastasis ; Medical prognosis ; Metastasis ; Micrometastases ; Neuroendocrine tumor ; Neuroendocrine tumors ; Pancreas ; Pathology ; Patients ; Small intestine ; Surgery</subject><ispartof>Human pathology, 2018-09, Vol.79, p.109-115</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Sep 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-39c22460f8a93692c4ccdc0e9376d6a2176a14b5dc76105a2c5aa492a28dfe443</citedby><cites>FETCH-LOGICAL-c495t-39c22460f8a93692c4ccdc0e9376d6a2176a14b5dc76105a2c5aa492a28dfe443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.humpath.2018.05.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,315,781,785,886,3551,27926,27927,45997</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29763717$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gibson, William E.</creatorcontrib><creatorcontrib>Gonzalez, Raul S.</creatorcontrib><creatorcontrib>Cates, Justin M.M.</creatorcontrib><creatorcontrib>Liu, Eric</creatorcontrib><creatorcontrib>Shi, Chanjuan</creatorcontrib><title>Hepatic micrometastases are associated with poor prognosis in patients with liver metastases from neuroendocrine tumors of the digestive tract</title><title>Human pathology</title><addtitle>Hum Pathol</addtitle><description>Pathologic examination of hepatic metastasectomies from patients with metastatic small intestinal or pancreatic neuroendocrine tumor frequently reveals micrometastases undetectable by radiologic or macroscopic gross examination. This finding raises the possibility that undetectable micrometastases remain in these patients after metastasectomy. Here we examined liver resections for micrometastases and assessed their impact on prognosis. Hepatic metastasectomies from 65 patients with neuroendocrine tumor of the small intestine (N = 43) or pancreas (N = 22) were reviewed for the presence of micrometastases, which were defined as microscopic tumor foci ≤1 mm in greatest dimension. Medical records were also reviewed for patient demographics, clinical history, and follow-up data. Micrometastasis was identified in 36 (55%) of 65 hepatic resection specimens. More hepatic micrometastases were seen in small intestinal cases than in pancreatic cases (29/43, 67%, versus 7/22, 32%; P < .01). They were typically present within portal tracts, sometimes with extension into the periportal region or sinusoidal spaces away from the portal tracts. Patients without hepatic micrometastases had fewer macrometastases or more R0 hepatic resections than those with micrometastases. The presence of hepatic micrometastases was associated with poor overall survival both before (hazard ratio [HR] 3.43; 95% CI 1.14–10.30; P = .03) and after accounting for confounding variables in stratified Cox regression (HR 4.82; 95% CI 1.0621.79; P = .04). In conclusion, hepatic micrometastases are common in patients with metastatic small intestinal or pancreatic neuroendocrine tumor and are independently associated with poor prognosis. These data suggest that surgical resection of hepatic metastases is likely not curative in these patients.
•Hepatic micrometastases are common in liver metastasis from digestive NETs.•Patients with hepatic micrometastases had more liver lesions than those without.•R0 resection was more likely achieved in patients without hepatic micrometastases.•Hepatic micrometastases are associated with poor overall survival.</description><subject>Liver</subject><subject>Liver metastasis</subject><subject>Medical prognosis</subject><subject>Metastasis</subject><subject>Micrometastases</subject><subject>Neuroendocrine tumor</subject><subject>Neuroendocrine tumors</subject><subject>Pancreas</subject><subject>Pathology</subject><subject>Patients</subject><subject>Small intestine</subject><subject>Surgery</subject><issn>0046-8177</issn><issn>1532-8392</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNqFkc2KFDEUhYMoTjv6CErAjZsq81NJKhtFBnWEATe6DpnkVleaqkqbpHrwJXxm03Q7jG6EQBb3nJN78iH0kpKWEirf7tpxnfe2jC0jtG-JaAmRj9CGCs6anmv2GG0I6WTTU6Uu0LOcd4RQKjrxFF0wrSRXVG3Qr2uoIcHhObgUZyg21wMZ2wTY5hxdsAU8vgtlxPsYE96nuF1iDhmHBR-9sJR8mk_hAAk_CBlqJF5gTREWH10KC-CyzjFlHAdcRsA-bCGX6sMlWVeeoyeDnTK8ON-X6Punj9-urpubr5-_XH24aVynRWm4dox1kgy91Vxq5jrnvCOguZJeWkaVtLS7Fd4pSYmwzAlrO80s6_0AXccv0btT7n69ncG72iHZyexTmG36aaIN5u_JEkazjQcjKeeK6xrw5hyQ4o-1VjBzyA6myS4Q12wY4bpXrO9olb7-R7qLa1pqPcOoUH2lQo4biZOqYsg5wXC_DCXmSNzszJm4ORI3RJhKvPpePWxy7_qDuArenwRQ__MQIJnsKjMHPiRwxfgY_vPEbwKIxFM</recordid><startdate>20180901</startdate><enddate>20180901</enddate><creator>Gibson, William E.</creator><creator>Gonzalez, Raul S.</creator><creator>Cates, Justin M.M.</creator><creator>Liu, Eric</creator><creator>Shi, Chanjuan</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180901</creationdate><title>Hepatic micrometastases are associated with poor prognosis in patients with liver metastases from neuroendocrine tumors of the digestive tract</title><author>Gibson, William E. ; Gonzalez, Raul S. ; Cates, Justin M.M. ; Liu, Eric ; Shi, Chanjuan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c495t-39c22460f8a93692c4ccdc0e9376d6a2176a14b5dc76105a2c5aa492a28dfe443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Liver</topic><topic>Liver metastasis</topic><topic>Medical prognosis</topic><topic>Metastasis</topic><topic>Micrometastases</topic><topic>Neuroendocrine tumor</topic><topic>Neuroendocrine tumors</topic><topic>Pancreas</topic><topic>Pathology</topic><topic>Patients</topic><topic>Small intestine</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gibson, William E.</creatorcontrib><creatorcontrib>Gonzalez, Raul S.</creatorcontrib><creatorcontrib>Cates, Justin M.M.</creatorcontrib><creatorcontrib>Liu, Eric</creatorcontrib><creatorcontrib>Shi, Chanjuan</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Human pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gibson, William E.</au><au>Gonzalez, Raul S.</au><au>Cates, Justin M.M.</au><au>Liu, Eric</au><au>Shi, Chanjuan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hepatic micrometastases are associated with poor prognosis in patients with liver metastases from neuroendocrine tumors of the digestive tract</atitle><jtitle>Human pathology</jtitle><addtitle>Hum Pathol</addtitle><date>2018-09-01</date><risdate>2018</risdate><volume>79</volume><spage>109</spage><epage>115</epage><pages>109-115</pages><issn>0046-8177</issn><eissn>1532-8392</eissn><abstract>Pathologic examination of hepatic metastasectomies from patients with metastatic small intestinal or pancreatic neuroendocrine tumor frequently reveals micrometastases undetectable by radiologic or macroscopic gross examination. This finding raises the possibility that undetectable micrometastases remain in these patients after metastasectomy. Here we examined liver resections for micrometastases and assessed their impact on prognosis. Hepatic metastasectomies from 65 patients with neuroendocrine tumor of the small intestine (N = 43) or pancreas (N = 22) were reviewed for the presence of micrometastases, which were defined as microscopic tumor foci ≤1 mm in greatest dimension. Medical records were also reviewed for patient demographics, clinical history, and follow-up data. Micrometastasis was identified in 36 (55%) of 65 hepatic resection specimens. More hepatic micrometastases were seen in small intestinal cases than in pancreatic cases (29/43, 67%, versus 7/22, 32%; P < .01). They were typically present within portal tracts, sometimes with extension into the periportal region or sinusoidal spaces away from the portal tracts. Patients without hepatic micrometastases had fewer macrometastases or more R0 hepatic resections than those with micrometastases. The presence of hepatic micrometastases was associated with poor overall survival both before (hazard ratio [HR] 3.43; 95% CI 1.14–10.30; P = .03) and after accounting for confounding variables in stratified Cox regression (HR 4.82; 95% CI 1.0621.79; P = .04). In conclusion, hepatic micrometastases are common in patients with metastatic small intestinal or pancreatic neuroendocrine tumor and are independently associated with poor prognosis. These data suggest that surgical resection of hepatic metastases is likely not curative in these patients.
•Hepatic micrometastases are common in liver metastasis from digestive NETs.•Patients with hepatic micrometastases had more liver lesions than those without.•R0 resection was more likely achieved in patients without hepatic micrometastases.•Hepatic micrometastases are associated with poor overall survival.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29763717</pmid><doi>10.1016/j.humpath.2018.05.006</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Liver Liver metastasis Medical prognosis Metastasis Micrometastases Neuroendocrine tumor Neuroendocrine tumors Pancreas Pathology Patients Small intestine Surgery |
| title | Hepatic micrometastases are associated with poor prognosis in patients with liver metastases from neuroendocrine tumors of the digestive tract |
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