Hepatic artery chemoembolization for the treatment of liver metastases from neuroendocrine tumors: a long-term follow-up in 123 patients

Neuroendocrine tumors (NETs) of the gastrointestinal tract have a propensity for hepatic metastases. Surgical resection for hepatic metastases remains the gold standard for long-term survival, but many patients present with multifocal tumors, precluding surgery with increasing use of chemoembolization. However, there are few studies examining long-term survival factors. We reviewed our 15-year experience with chemoembolization in 123 patients with unresectable NET liver metastases, whose prognosis was evaluated upon baseline clinical factors. There were 64 males (53%) and 59 females (47%). Average age at presentation was 56 years (range: 14.3-85.5 years). Abdominal pain (44%) was the most common presenting symptom, followed by diarrhea (30%) and weight lost (22%). Patients underwent an average 7.3 cycles of chemoembolization (range 1-32 cycles). Responses: 62% of patients had PR; 24% had stable disease and 14% had tumor progression. Overall 3-, 5- and 10-year survivals were 59, 36 and 20% of patients with a mean follow-up of 3.2 years (range 2 weeks-18.3 years) and mean survival of 3.3 years. Univariate analysis showed that age greater than 60 years had worse outcome (P < 0.01), as did baseline serum albumin of <= 3.5 g/dL and prothrombin time >13 s. Location of the primary tumor (P = 0.68), gender (P = 0.4) and serum NET peptide levels did not influence survival. However, multivariate analysis showed that a low baseline serum albumin level was an independent factor for prognosis (P = 0.003). Chemoembolization for unresectable NETs metastatic to liver is useful for tumor size reduction, symptom palliation and can be associated with prolonged survival.