Contemporary Short-Term Outcomes of Liver-Directed Therapy for Neuroendocrine Tumor Liver Metastases.

Abstract

The roles and benefits of locoregional treatments in metastatic neuroendocrine tumors (NETs) need reassessment for contemporary decision making and counseling. We examined contemporary short-term outcomes of liver-directed therapy for metastatic NETs. We conducted a population-based retrospective cohort study of patients with metastatic NETs (2000-2019) undergoing liver embolization or resection. Outcomes were 30-day major morbidity (Clavien-Dindo grade 3-5) and mortality. Logistic regression examined factors associated with outcomes in each group. Overall, 1054 patients underwent 1224 liver embolizations, and 502 liver resections were performed. Median length of hospital stay was 1 day (interquartile range [IQR] 1-4) for liver embolization and 7 days (IQR 5-9) for liver resection. Thirty-day major morbidity occurred in 10% of liver embolizations, including 40 (3.3%) deaths, and in 22.5% after liver resections, including 11 (2.2%) deaths. Factors independently associated with increased risk after liver embolization were prior embolization (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.46-0.89) and combination of prior liver embolization and resection (OR 0.50, 95% CI 0.28-0.87). For liver resection, age >70 years was independently associated with increased odds of major morbidity (OR 2.08, 95% CI 1.12-3.84) and metachronous metastases with lower odds of major morbidity (OR 0.62, 95% CI 0.39-0.99). In this contemporary cohort, mortality after liver embolization was comparable with that after liver resection. Prior liver-directed therapy and older age were associated with higher risk of major morbidity This information is important when discussing the use and choice of liver-directed therapies and counseling patients with metastatic NETs.