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Rossi RE, Milanetto AC, Andreasi V, Campana D, Coppa J, Nappo G, Rinzivillo M, Invernizzi P, Modica R, David A, Partelli S, Lamberti G, Mazzaferro V, Zerbi A, Panzuto F, Pasquali C, Falconi M, Massironi S. Risk of preoperative understaging of duodenal neuroendocrine neoplasms: a plea for caution in the treatment strategy. J Endocrinol Invest 2021; 44:2227-2234. [PMID: 33651317 DOI: 10.1007/s40618-021-01528-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/04/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Pretreatment staging is the milestone for planning either surgical or endoscopic treatment in duodenal neuroendocrine neoplasms (dNENs). Herein, a series of surgically treated dNEN patients was evaluated to assess the concordance between the pre- and postsurgical staging. METHODS Retrospective analysis of patients with a histologically confirmed diagnosis of dNENs, who underwent surgical resection observed at eight Italian tertiary referral centers. The presurgical TNM stage, based on the radiological and functional imaging, was compared with the pathological TNM stage, after surgery. RESULTS From 2000 to 2019, 109 patients were included. Sixty-six patients had G1, 26 a G2, 7 a G3 dNEN (Ki-67 not available in 10 patients). In 46/109 patients (42%) there was disagreement between the pre- and postsurgical staging, being it understaged in 42 patients (38%), overstaged in 4 (3%). As regards understaging, in 25 patients (22.9%), metastatic loco-regional nodes (N) resulted undetected at both radiological and functional imaging. Understaging due to the presence of distal micrometastases (M) was observed in 2 cases (1.8%). Underestimation of tumor extent (T) was observed in 12 patients (11%); in three cases the tumor was understaged both in T and N extent. CONCLUSIONS Conventional imaging has a poor detection rate for loco-regional nodes and micrometastases in the presurgical setting of the dNENs. These results represent important advice when local conservative approaches, such as endoscopy or local surgical excision are considered and it represents a strong recommendation to include endoscopic ultrasound in the preoperative tools for a more accurate local staging.
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Affiliation(s)
- R E Rossi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy.
| | - A C Milanetto
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padua, Italy
| | - V Andreasi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - D Campana
- Department of Experimental, Diagnostic and Specialty Medicine, ENETS Center of Excellence, Bologna University, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - J Coppa
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy
| | - G Nappo
- Pancreatic Surgery, Humanitas Clinical, and Research Center-IRCCS, ENETS Center of Excellence, Humanitas University, Milan, Rozzano, Italy
| | - M Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - P Invernizzi
- Division of Gastroenterology, San Gerardo Hospital, Bicocca School of Medicine, University of Milano, Monza, Italy
| | - R Modica
- Division of Endocrinology, Department of Clinical Medicine and Surgery, ENETS Center of Excellence, University "Federico II" of Naples, Naples, Italy
| | - A David
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padua, Italy
| | - S Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - G Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, ENETS Center of Excellence, Bologna University, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - V Mazzaferro
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Zerbi
- Pancreatic Surgery, Humanitas Clinical, and Research Center-IRCCS, ENETS Center of Excellence, Humanitas University, Milan, Rozzano, Italy
| | - F Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - C Pasquali
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padua, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - S Massironi
- Division of Gastroenterology, San Gerardo Hospital, Bicocca School of Medicine, University of Milano, Monza, Italy
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Prinzi N, Seregni E, Raimondi A, Maccauro M, Corti F, Lo Russo G, Nichetti F, Torchio M, Coppa J, Peverelli G, Pagani F, Di Bartolomeo M, Mazzaferro V, de Braud F, Pusceddu S. The role of modulation of somatostatin analogues (SSAs) in association to peptide receptor radionuclide therapy (PRRT) after SSAs progression disease (PD) in advanced well-differentiated (WD) entero-pancreatic neuroendocrine tumours (EP-NETs). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Milione M, Miceli R, Pellegrinelli A, Centonze G, Barretta F, Pusceddu S, Giacomelli L, Coppa J, Mazzaferro V, Sozzi G, Anichini A, de Braud F. Predictive factors in GEP-NEN: The integrated role of Ki67, beta-catenin and morphology. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx368.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Citterio D, Pusceddu S, Facciorusso A, Coppa J, Milione M, Buzzoni R, Bongini M, deBraud F, Mazzaferro V. Primary tumour resection may improve survival in functional well-differentiated neuroendocrine tumours metastatic to the liver. Eur J Surg Oncol 2017; 43:380-387. [DOI: 10.1016/j.ejso.2016.10.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 01/09/2023] Open
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Mazzaferro V, Sposito C, Coppa J, Miceli R, Bhoori S, Bongini M, Camerini T, Milione M, Regalia E, Spreafico C, Gangeri L, Buzzoni R, de Braud FG, De Feo T, Mariani L. The Long-Term Benefit of Liver Transplantation for Hepatic Metastases From Neuroendocrine Tumors. Am J Transplant 2016; 16:2892-2902. [PMID: 27134017 DOI: 10.1111/ajt.13831] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 04/10/2016] [Accepted: 04/10/2016] [Indexed: 01/25/2023]
Abstract
Selection criteria and benefit of liver transplantation for hepatic metastases from neuroendocrine tumors (NETs) remain uncertain. Eighty-eight consecutive patients with metastatic NETs eligible for liver transplantation according to Milan-NET criteria were offered transplant (n = 42) versus nontransplant options (n = 46) depending on list dynamics, patient disposition, and age. Tumor burden between groups did not differ. Transplant patients were younger (40.5 vs. 55.5 years; p < 0.001). Long-term outcomes were compared after matching between groups made on multiple Cox models adjusted for propensity score built on logistic models. Survival benefit was the difference in mean survival between transplant versus nontransplant options. No patients were lost or died without recurrence. Median follow-up was 122 months. The transplant group showed a significant advantage over nontransplant strategies at 5 and 10 years in survival (97.2% and 88.8% vs. 50.9% and 22.4%, respectively; p < 0.001) and time-to-progression (13.1% and 13.1% vs. 83.5% and 89%; p < 0.001). After adjustment for propensity score, survival advantage of the transplant group was significant (hazard ratio = 7.4; 95% confidence interval (CI): 2.4-23.0; p = 0.001). Adjusted transplant-related survival benefit was 6.82 months (95% CI: 1.10-12.54; p = 0.019) and 38.43 months (95% CI: 21.41-55.45; p < 0.001) at 5 and 10 years, respectively. Liver transplantation for metastatic NETs under restrictive criteria provides excellent long-term outcome. Transplant-related survival benefit increases over time and maximizes after 10 years.
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Affiliation(s)
- V Mazzaferro
- Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy
| | - C Sposito
- Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy
| | - J Coppa
- Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy
| | - R Miceli
- Trial Office and Biomedical Statistics, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - S Bhoori
- Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy
| | - M Bongini
- Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy
| | - T Camerini
- Trial Office and Biomedical Statistics, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - M Milione
- Pathology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - E Regalia
- Surgery and Hepatology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy
| | - C Spreafico
- Interventional Radiology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - L Gangeri
- Psychology, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - R Buzzoni
- Medical Oncology Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy
| | - F G de Braud
- Medical Oncology Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), University of Milan, Milan, Italy
| | - T De Feo
- North Italian Transplant Procurement Agency, Organ and Tissue Transplant Immunology, IRCCS Policlinico Hospital, Milan, Italy
| | - L Mariani
- Trial Office and Biomedical Statistics, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
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Mennitto A, Cotsoglou C, Caporale M, Scotti M, Berenato R, Coppa J, Di Bartolomeo M, Milione M, Bossi I, de Braud F, Mazzaferro V, Filippo P. Perioperative triplet chemotherapy plus bevacizumab (bev) in patients with borderline resectable colorectal cancer liver metastases (CLM): Preliminary safety and activity. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mennitto A, Cotsoglou C, Caporale M, Scotti M, Berenato R, Coppa J, Di Bartolomeo M, Milione M, Bossi I, de Braud F, Mazzaferro V, Pietrantonio F. Patients with borderline resectable colorectal cancer liver metastases (CLM): preliminary safety and activity of perioperative triplet chemotherapy plus bevacizumab (bev). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Coppa J, Pulvirenti A, Schiavo M, Romito R, Collini P, Di Bartolomeo M, Fabbri A, Regalia E, Mazzaferro V. Resection versus transplantation for liver metastases from neuroendocrine tumors. Transplant Proc 2001; 33:1537-9. [PMID: 11267413 DOI: 10.1016/s0041-1345(00)02586-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- J Coppa
- Department of Surgery, Liver Transplantation Unit, Milan, Italy
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Regalia E, Coppa J, Pulvirenti A, Romito R, Schiavo M, Burgoa L, Mazzaferro V. Liver transplantation for small hepatocellular carcinoma in cirrhosis: analysis of our experience. Transplant Proc 2001; 33:1442-4. [PMID: 11267365 DOI: 10.1016/s0041-1345(00)02546-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- E Regalia
- Department of Surgery-Liver Transplantation Unit, National Cancer Institute, (Istituto Nazionale Tumori), Milan, Italy
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Mazzaferro V, Tagger A, Schiavo M, Regalia E, Pulvirenti A, Ribero ML, Coppa J, Romito R, Burgoa L, Zucchini N, Urbanek T, Bonino F. Prevention of recurrent hepatitis C after liver transplantation with early interferon and ribavirin treatment. Transplant Proc 2001; 33:1355-7. [PMID: 11267325 DOI: 10.1016/s0041-1345(00)02508-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- V Mazzaferro
- Department of Surgery, Gastrointestinal Surgery and Liver Transplantation Unit, Pathology Unit, National Cancer Institute, Milan, Italy
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Pulvirenti A, Garbagnati F, Regalia E, Coppa J, Marchiano A, Romito R, Schiavo M, Fabbri A, Burgoa L, Mazzaferro V. Experience with radiofrequency ablation of small hepatocellular carcinomas before liver transplantation. Transplant Proc 2001; 33:1516-7. [PMID: 11267402 DOI: 10.1016/s0041-1345(00)02577-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A Pulvirenti
- Department of Surgery, Liver Transplantation Unit, National Cancer Institute (Istituto Nazionale Tumori), Milan, Italy
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Regalia E, Fassati LR, Valente U, Pulvirenti A, Damilano I, Dardano G, Montalto F, Coppa J, Mazzaferro V. Pattern and management of recurrent hepatocellular carcinoma after liver transplantation. J Hepatobiliary Pancreat Surg 1998; 5:29-34. [PMID: 9683751 DOI: 10.1007/pl00009947] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A series of 132 patients who underwent liver transplantation for primary liver cancer was collected from three different Italian hospitals and studied for recurrence of hepatocellular carcinoma after liver replacement. Twenty-one patients (15.9%) had a neoplastic recurrence after an average follow-up period of 7.8 months after transplantation (range, 1-25 months); 15 (71%) occurred within the first 18 months after transplant and only two recurred later than 2 years. The sites of recurrence were grafted liver (19%), lung (19%), bone (14%), and other (5%). Eight patients (38%) had multiple organ involvement at the onset. After 1, 2, 3, and 4 years the overall survival rates were 62%, 43%, 29%, and 23%, respectively. The tumor factors related to early cancer recurrence after transplantation were diameter of nodules more than 3 cm (P < 0.05), tumor stage not meeting the "Milan criteria" (P < 0.03), and presence of peri-tumoral capsule (P < 0.05); the number of nodules, TNM stage, presence of vascular invasion, alpha-fetoprotein level more than 150 UI/l, pre-transplant chemoembolization and resectability of cancer deposits did not seem to be related to early recurrence. The prognosis differed in the 7 patients with resectable recurrences (57% 4-year survival) and the 14 patients with unresectable disease (14% 4-year survival) (P < 0.02). Better patient selection and new combined medical strategies could reduce the incidence of and mortality from liver cancer recurrence after transplantation. The role of surgical resection of recurrence should be further investigated.
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Affiliation(s)
- E Regalia
- Department of Surgery, Liver Transplantation Unit, National Cancer Institute, Via Venezian 1-20133, Milan, Italy
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