Zhonghua Wai Ke Za Zhi. 2026 Aug 31;64(10):1106-1114. doi: 10.3760/cma.j.cn112139-20260311-00096. Online ahead of print.
ABSTRACT
Objectives: To investigate the impact of liver metastatic burden on the prognosis of patients with pancreatic neuroendocrine tumor (pNET) complicated by synchronous liver metastases who undergo curative resection,and to evaluate the value of preoperative systemic therapy/postoperative adjuvant therapy in subgroups with different metastatic burdens. Methods: This is a retrospective case series study. A total of 54 patients with pNET and liver metastases who underwent synchronous curative resection at Peking University Third Hospital from January 2016 to December 2025 were enrolled. 26 males and 28 females; with an age (M(IQR)) of 52(38)years(range:17 to 78 years). A combined scoring system based on the number and maximum diameter of liver metastatic lesions was constructed, and patients were divided into a high-burden group (n=33) and a low-burden group (n=21) using X-tile software. Kaplan-Meier method,log-rank test, and Cox regression analysis were used to identify prognostic factors, and the value of different systemic therapy regimens was evaluated by stratification. Results: Liver metastatic burden was an independent adverse prognostic factor for recurrence-free survival (RFS) in patients with pNET and liver metastases after curative resection (HR=3.323,95%CI:1.455 to 7.594,P=0.001). Subgroup analysis showed that preoperative systemic therapy significantly affected RFS in the high-burden group (P=0.013). Among patients receiving preoperative systemic therapy,those treated with chemotherapy or targeted therapy achieved significantly superior RFS compared with patients receiving somatostatin analog (SSA) monotherapy (HR=10.27, 95%CI: 1.262 to 83.580, P=0.008) and patients without preoperative therapy (HR=6.537, 95%CI: 0.789 to 54.150, P=0.047). Preoperative systemic therapy exerted no significant influence on OS in either the high-or low-burden group (both P>0.05). Similarly, postoperative adjuvant therapy showed no significant effects on RFS or OS in both subgroups (all P>0.05). Preoperative chemotherapy or targeted therapy, preoperative SSA combined with chemotherapy or targeted therapy followed by postoperative SSA could significantly improve RFS in high-burden patients (P<0.01). Conclusions: Liver metastatic burden is an independent prognostic factor for RFS after synchronous curative resection. Preoperative chemotherapy or targeted therapy can improve RFS in high-burden patients,and the sequential systemic therapy strategy based on chemotherapy or targeted therapy and SSA can further enhance RFS in this subgroup.
PMID:42669447 | DOI:10.3760/cma.j.cn112139-20260311-00096