Guiding Treatment Decisions in Neuroendocrine Liver Metastasis: A Multinational Comparative Analysis of Liver Transplantation and Systemic Therapies
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ID: 315714
2026
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Abstract
Abstract Background Liver transplantation (LT) is considered a potential curative option for neuroendocrine liver metastases (NELM), yet its survival benefit compared to modern systemic therapies (ST) remains a subject of debate. Aims To rigorously compare overall survival (OS) between LT and ST in patients with NELM who met the Milan criteria, utilizing a large international database. Methods A multinational, 17-center retrospective cohort study was conducted involving specialized hepatobiliary centers. Patients with pathology-proven NELM undergoing either LT or ST as their primary liver-directed strategy were included. To minimize selection bias, a 1:1 propensity score matching (PSM) was performed based on key prognostic variables: age, primary tumor location, tumor grade, and presence of extrahepatic disease. The primary outcome was OS calculated from the date of NELM diagnosis. Results From a total cohort of 1,281 patients, 81 in the LT group and 99 in the ST group met the Milan criteria. PSM resulted in a balanced cohort of 136 patients (68 per group). In the matched analysis, the median OS was 215 months (95% CI: 176–NA) for LT compared to 166 months (95% CI: 106–NA) for ST. This difference was not statistically significant (Hazard Ratio [HR]: 1.24; 95% CI: 0.65-2.36; p=0.5). The 10-year OS probability was 67% for LT and 57% for ST. Subgroup analyses, including stratification by Ki-67 index (<10%) and exclusion of 90-day mortality, confirmed no significant survival advantage for the transplant cohort. Conclusion In this large multicenter analysis, LT did not demonstrate a statistically significant survival benefit over contemporary systemic therapies for patients meeting Milan criteria. While LT remains a valid option for specific refractory cases, these findings suggest that non-surgical management with modern systemic agents offers comparable long-term outcomes for well-selected patients.
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openalex_W7163337929
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| Authors | D Eshmuminov, L Frey, V Lopez-Lopez, J Oberholzer |
| Journal | the british journal of surgery |
| Year | 2026 |
| DOI |
10.1093/bjs/znag055.057
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| URL | |
| Keywords | Keywords not found |
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