Transplant may benefit patients with tumors of gastroentero-pancreatic origin

WASHINGTON — The competitive survival rates achieved using nontransplantation options for patients with metastatic neuroendocrine tumors of gastroentero-pancreatic origin along with the lack of accepted selection criteria has made the use of liver transplant in these cases controversial, a speaker said here.

A long-term study, however, has demonstrated significant transplant-associated survival benefit in these patients that may support the use of a MELD exception, Vincenzo Mazzaferro, MD, in the department of surgery and hepatology at Fondazione IRCCS Istituto Nazionale dei Tumori di Milano in Italy, said.

“Liver transplantation under restrictive criteria may achieve in patients with neuroendocrine tumors the best survival ever,” Mazzaferro said.

The study analyzed 215 consecutive patients referred for liver transplantation with hepatic metastases from neuroendocrine tumors of gastroentero-pancreatic origin (GEP-NET) during a 13-year period at a single institution. Median follow-up was 95 months.

Thirty-eight patients underwent transplant after resection of the primary tumor (group 1). Due to age, compliance and comorbidities, 72 patients were treated with nontransplant options after primary tumor removal (group 2). Fifty-five patients underwent curative primary plus liver resections (group 3), and the final 50 received medical treatment only (group 4).

Cox models adjusted for propensity score showed a significant survival advantage for group 1 over the remaining groups (P=.012). Overall survival in group 1 was 96.8% at 5 years and 92.2% at 10 years, compared with 59.3% and 37.7%, respectively, in group 2 (P<.0001).

Transplant-associated survival benefit related to those in group 1 was 11.6 months at 5 years and 42.4 months at 10 years (P<.001), according to a univariate analysis. With multivariate analysis, transplant-associated survival benefit was 9.98 months and 29.5 months at 5 and 10 years, respectively (P<.001).

“The observed benefit of transplantation … in comparison with nontransplant options may justify the enlistment of these patients as a MELD exception,” Mazzaferro said.

Disclosure: Mazzaferro is a member of the advisory committee/review panel for Bayer; received grant/research support from Nordion; and receives speaking/teaching support from Merck Serono.

For more information:

Mazzaferro V. #6: Magnitude of Survival Benefit After Liver Transplantation (LT) for Metastatic Neuroendocrine Tumors (NET) of Gastroentero-pancreatic (GEP) Origin. Presented at: The Liver Meeting 2013; Nov. 1-5, Washington.