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A Novel Nomogram to Predict the Prognosis of Patients Undergoing Liver Resection for Neuroendocrine Liver Metastasis: an Analysis of the Italian Neuroendocrine Liver Metastasis Database

  • 2016 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Even though surgery remains the only potentially curative option for patients with neuroendocrine liver metastases, the factors determining a patient’s prognosis following hepatectomy are poorly understood. Using a multicentric database including patients who underwent hepatectomy for NELMs at seven tertiary referral hepato-biliary-pancreatic centers between January 1990 and December 2014, we sought to identify the predictors of survival and develop a clinical tool to predict patient’s prognosis after liver resection for NELMs. The median age of the 238 patients included in the study was 61.9 years (interquartile range 51.5–70.1) and 55.9 % (n = 133) of patients were men. The number of NELMs (hazard ratio = 1.05), tumor size (HR = 1.01), and Ki-67 index (HR = 1.07) were the predictors of overall survival. These variables were used to develop a nomogram able to predict survival. According to the predicted 5-year OS, patients were divided into three different risk classes: 19.3, 55.5, and 25.2 % of patients were in low (>80 % predicted 5-year OS), medium (40–80 % predicted 5-year OS), and high (<40 % predicted 5-year OS) risk classes. The 10-year OS was 97.0, 55.9, and 20.0 % in the low, medium, and high-risk classes, respectively (p < 0.001). We developed a novel nomogram that accurately (c-index >70 %) staged and predicted the prognosis of patients undergoing liver resection for NELMs.

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Acknowledgments

We want to thank Prof. Giuseppe Verlato, Head of the Unit of Epidemiology and Public Health, Department Diagnostics and Public Health, School of Medicine, University of Verona, who critically revised the statistical analyses. The study was supported in part by the Ministry of University and Research (FIRB RBAP10AHJB) and Associazione Italiana Ricerca Cancro (AIRC grant 5x1000 12182).

Author Contribution

- Design of the work: All Authors

- Analysis and interpretation of data for the work: Calogero Iacono, Andrea Ruzzenente, and Fabio Bagante

- Drafting the work: Calogero Iacono, Andrea Ruzzenente, Fabio Bagante

- Revising it critically for important intellectual content: All Authors

- Final approval of the version to be published: All Authors

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: All Authors

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    Authors and Affiliations

    1. General and Hepatobiliary Surgery, Department of Surgery and Oncology, University of Verona, School of Medicine, Verona, Italy

      Andrea Ruzzenente, Fabio Bagante, Francesca Bertuzzo, Alfredo Guglielmi & Calogero Iacono

    2. Hepatobiliary Surgery Division, Department of Surgery, IRCCS San Raffaele Hospital, School of Medicine, Milan, Italy

      Luca Aldrighetti & Francesca Ratti

    3. General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, School of Medicine, Bologna, Italy

      Giorgio Ercolani & Alessandro Cucchetti

    4. Hepatobiliary Surgery Unit, A. Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy

      Felice Giuliante & Agostino M. De Rose

    5. Department of General and Oncologic Surgery, Ospedale Mauriziano Umberto I, Turin, Italy

      Alessandro Ferrero & Nadia Russolillo

    6. Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas Reseach Hospital, Humanitas University, Rozzano, Milano, Italy

      Guido Torzilli & Matteo Cimino

    7. Department of Surgery, Regina Elena National Cancer Institute, Rome, Italy

      Gian Luca Grazi & Pasquale Perri

    8. Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy

      Ivana Cataldo & Aldo Scarpa

    9. ARC-NET Research Center, University and Hospital Trust of Verona, Verona, Italy

      Ivana Cataldo & Aldo Scarpa

    10. Department of Surgery and Oncology, Division of General and Hepatobiliary Surgery, School of Medicine, University of Verona, P. le L.A. Scuro, 37134, Verona, Italy

      Calogero Iacono

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    1. Andrea Ruzzenente
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    Correspondence to Calogero Iacono.

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    Additional information

    Andrea Ruzzenente MD, PhD and Fabio Bagante MD contributed equally to this work.

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    Figure S1

    Calibration Plot for the Nomogram (GIF 11 kb)

    Table S1

    Multivariable Analysis for Overall Survival Including 195 Patients with Well-Differentiated (WHO G1/G2) NELMs (DOC 28 kb)

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    Ruzzenente, A., Bagante, F., Bertuzzo, F. et al. A Novel Nomogram to Predict the Prognosis of Patients Undergoing Liver Resection for Neuroendocrine Liver Metastasis: an Analysis of the Italian Neuroendocrine Liver Metastasis Database. J Gastrointest Surg 21, 41–48 (2017). https://doi.org/10.1007/s11605-016-3228-6

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