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Treatment of Liver Metastases from Midgut Neuroendocrine Tumours: A Systematic Review and Meta-Analysis

Strong evidence comparing different treatment options for liver metastases (LM) arising from gastroenteropancreatic neuroendocrine tumours (GEP-NET) is lacking. The aim of this study was to determine which intervention for LMs from GEP-NETs shows the longest overall survival (OS). A systematic searc...

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Autores principales: Kaçmaz, Enes, Heidsma, Charlotte M., Besselink, Marc G. H., Dreijerink, Koen M. A., Klümpen, Heinz-Josef, Nieveen van Dijkum, Elisabeth J. M., Engelsman, Anton F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462926/
https://www.ncbi.nlm.nih.gov/pubmed/30909512
http://dx.doi.org/10.3390/jcm8030403
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author Kaçmaz, Enes
Heidsma, Charlotte M.
Besselink, Marc G. H.
Dreijerink, Koen M. A.
Klümpen, Heinz-Josef
Nieveen van Dijkum, Elisabeth J. M.
Engelsman, Anton F.
author_facet Kaçmaz, Enes
Heidsma, Charlotte M.
Besselink, Marc G. H.
Dreijerink, Koen M. A.
Klümpen, Heinz-Josef
Nieveen van Dijkum, Elisabeth J. M.
Engelsman, Anton F.
author_sort Kaçmaz, Enes
collection PubMed
description Strong evidence comparing different treatment options for liver metastases (LM) arising from gastroenteropancreatic neuroendocrine tumours (GEP-NET) is lacking. The aim of this study was to determine which intervention for LMs from GEP-NETs shows the longest overall survival (OS). A systematic search was performed in MEDLINE, Embase and the Cochrane Library in February 2018. Studies reporting on patients with LMs of any grade of sporadic GEP-NET comparing two intervention groups were included for analysis. Meta-analyses were performed where possible. Eleven studies, with a total of 1108, patients were included; 662 patients had LM from pancreatic NETs (pNET), 164 patients from small-bowel NETs (SB-NET) and 282 patients of unknown origin. Improved 5-year OS was observed for surgery vs. chemotherapy (OR 0.05 95% CI [0.01, 0.21] p < 0.0001), for surgery vs. embolization (OR 0.18 95% CI [0.05, 0.61] p = 0.006) and for LM resection vs. no LM resection (OR 0.15 95% CI [0.05, 0.42] p = 0.0003). This is the largest meta-analysis performed comparing different interventions for LMs from GEP-NETs. Despite the high risk of bias and heterogeneity of data, surgical resection for all tumour grades results in the longest overall survival. Chemotherapy and embolization should be considered as an alternative in case surgery is not feasible.
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spelling pubmed-64629262019-04-19 Treatment of Liver Metastases from Midgut Neuroendocrine Tumours: A Systematic Review and Meta-Analysis Kaçmaz, Enes Heidsma, Charlotte M. Besselink, Marc G. H. Dreijerink, Koen M. A. Klümpen, Heinz-Josef Nieveen van Dijkum, Elisabeth J. M. Engelsman, Anton F. J Clin Med Article Strong evidence comparing different treatment options for liver metastases (LM) arising from gastroenteropancreatic neuroendocrine tumours (GEP-NET) is lacking. The aim of this study was to determine which intervention for LMs from GEP-NETs shows the longest overall survival (OS). A systematic search was performed in MEDLINE, Embase and the Cochrane Library in February 2018. Studies reporting on patients with LMs of any grade of sporadic GEP-NET comparing two intervention groups were included for analysis. Meta-analyses were performed where possible. Eleven studies, with a total of 1108, patients were included; 662 patients had LM from pancreatic NETs (pNET), 164 patients from small-bowel NETs (SB-NET) and 282 patients of unknown origin. Improved 5-year OS was observed for surgery vs. chemotherapy (OR 0.05 95% CI [0.01, 0.21] p < 0.0001), for surgery vs. embolization (OR 0.18 95% CI [0.05, 0.61] p = 0.006) and for LM resection vs. no LM resection (OR 0.15 95% CI [0.05, 0.42] p = 0.0003). This is the largest meta-analysis performed comparing different interventions for LMs from GEP-NETs. Despite the high risk of bias and heterogeneity of data, surgical resection for all tumour grades results in the longest overall survival. Chemotherapy and embolization should be considered as an alternative in case surgery is not feasible. MDPI 2019-03-22 /pmc/articles/PMC6462926/ /pubmed/30909512 http://dx.doi.org/10.3390/jcm8030403 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kaçmaz, Enes
Heidsma, Charlotte M.
Besselink, Marc G. H.
Dreijerink, Koen M. A.
Klümpen, Heinz-Josef
Nieveen van Dijkum, Elisabeth J. M.
Engelsman, Anton F.
Treatment of Liver Metastases from Midgut Neuroendocrine Tumours: A Systematic Review and Meta-Analysis
title Treatment of Liver Metastases from Midgut Neuroendocrine Tumours: A Systematic Review and Meta-Analysis
title_full Treatment of Liver Metastases from Midgut Neuroendocrine Tumours: A Systematic Review and Meta-Analysis
title_fullStr Treatment of Liver Metastases from Midgut Neuroendocrine Tumours: A Systematic Review and Meta-Analysis
title_full_unstemmed Treatment of Liver Metastases from Midgut Neuroendocrine Tumours: A Systematic Review and Meta-Analysis
title_short Treatment of Liver Metastases from Midgut Neuroendocrine Tumours: A Systematic Review and Meta-Analysis
title_sort treatment of liver metastases from midgut neuroendocrine tumours: a systematic review and meta-analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462926/
https://www.ncbi.nlm.nih.gov/pubmed/30909512
http://dx.doi.org/10.3390/jcm8030403
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