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Multi-institutional Development and External Validation of a Nomogram Predicting Recurrence After Curative Liver Resection for Neuroendocrine Liver Metastasis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objectives

To establish and externally validate a novel nomogram to predict recurrence of patients undergoing curative liver resection for neuroendocrine liver metastasis (NELM).

Methods

A total of 279 patients who underwent curative liver resection for NELM identified from an international multicenter database were utilized to develop a nomogram to predict recurrence; 98 cases from two different institutions were used to externally validate the nomogram.

Results

Among 279 patients in the development cohort, median age was 57 years, and 50.5% were male. On multivariate analysis, primary tumor location (pancreatic vs nonpancreatic, HR 2.1, p = 0.004), tumor grade (Ref. well, moderate HR 1.9, p = 0.022; poor HR 1.6, p = 0.238), lymph node metastasis (positive vs negative, HR 2.6, p = 0.002), and extent of resection (major vs parenchymal-sparing resection, HR 0.3, p = 0.001) were independently associated with recurrence-free survival. The beta coefficients from the final multivariable model were utilized to develop a nomogram. The nomogram demonstrated good ability to predict risk of recurrence (training cohort, C-index 0.754; validation cohort, C-index 0.748). The calibrated nomogram predicted recurrence-free survival that closely corresponded to actual recurrence. Decision curve analysis demonstrated that the nomogram had a good net benefit for most of the threshold probabilities, especially between 20 and 60%, in both development and validation cohorts.

Conclusions

The externally validated novel nomogram predicted 3- and 5-year recurrence-free survival among patients with NELM. Prediction of individual recurrence risk may help guide personalized estimates of prognosis, as well as surveillance protocols and consideration of adjuvant therapies.

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Acknowledgment

Jun-Xi Xiang and Xu-Feng Zhang were supported by the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University of China (No. XJTU1AF-CRF-2017-004).

Author information

Author notes

  1. Jun-Xi Xiang and Xu-Feng Zhang have contributed equally to this study.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Jun-Xi Xiang MD & Xu-Feng Zhang MD, PhD

  2. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Health Services Management and Policy, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Xu-Feng Zhang MD, PhD & Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)

  3. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss MD

  4. Department of Surgery, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy

    Luca Aldrighetti MD

  5. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides MD

  6. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer MD

  7. Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA

    Ryan C. Fields MD

  8. Department of Surgery, Emory University, Atlanta, GA, USA

    Shishir Kumar Maithel MD

  9. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD

Authors
  1. Jun-Xi Xiang MD
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  2. Xu-Feng Zhang MD, PhD
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  3. Matthew Weiss MD
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  4. Luca Aldrighetti MD
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  5. George A. Poultsides MD
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  6. Todd W. Bauer MD
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  7. Ryan C. Fields MD
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  8. Shishir Kumar Maithel MD
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  9. Hugo P. Marques MD
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  10. Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)
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Contributions

Study design, JX Xiang, XF Zhang, TM Pawlik; Data collection and interpretation, L Aldrighetti, GA Poultsides, TW Bauer, RC Fields, SK Maithel, HP Marques, M Weiss; Data analysis, JX Xiang, XF Zhang; Drafting, XJ Xiang, XF Zhang; Revision of the draft: XF Zhang, TM Pawlik.

Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.).

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Xiang, JX., Zhang, XF., Weiss, M. et al. Multi-institutional Development and External Validation of a Nomogram Predicting Recurrence After Curative Liver Resection for Neuroendocrine Liver Metastasis. Ann Surg Oncol 27, 3717–3726 (2020). https://doi.org/10.1245/s10434-020-08620-5

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  • DOI: https://doi.org/10.1245/s10434-020-08620-5

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