减瘤术在神经内分泌肿瘤肝转移应用中的安全性和疗效

doi:10.3877/cma.j.issn.2095-3232.2026.01.014

目的

探讨神经内分泌肿瘤肝转移（NETLM）减瘤术的安全性、近期转归及远期疗效。

方法

回顾性分析2021年9月至2023年4月在复旦大学附属肿瘤医院行减瘤术的31例NETLM患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男14例，女17例；年龄55（46，60）岁。NETLM患者原发灶主要为胃肠胰，共25例，占比80.6%。肝转移灶G2级占81%（25/31），非功能性肿瘤占94%（29/31）。27例患者接受过术前药物治疗，21例术前接受过经导管动脉栓塞术治疗，16例接受原发灶切除。观察患者手术时间、术中出血量及输血情况等手术情况；术后近期转归包括术后住院时间、术后并发症发生率及病死率。长期转归为术后无进展生存期（PFS）。生存分析采用Kaplan-Meier生存曲线。

结果

31例NETLM患者肝转移瘤负荷为（40±3）%，肝转移灶最大径10.0（8.5，13.5） cm；手术时间168（135，235） min；术中出血量800（300，1 000） ml，术中需要输血17例；术后住院时间6（5，7）d，术后并发症发生率48%（15/31），无围手术期死亡；术后6例出现肿瘤级别升高，中位PFS为12.0（95% CI：6.9~17.1）个月，6、12及18个月无进展生存率分别为85%、56%及37%。

结论

NETLM患者外科减瘤术是相对安全的，能够获得较好的生存获益，并能够对后期治疗有一定的指导作用。

关键词: 神经内分泌肿瘤, 肝转移癌, 减积手术, 无进展生存期, 预后

Objective

To evaluate the safety, short-term outcome and long-term efficacy of cytoreductive surgery for neuroendocrine tumor liver metastases (NETLM).

Methods

Clinical data of 31 patients with NETLM undergoing cytoreductive surgery in Fudan University Shanghai Cancer Center from September 2021 to April 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 14 patients were male and 17 female, with a median age of 55(46,60) years. Gastrointestinal pancreas was the primary lesion site of NETLM patients (n=25, 80.6%). Patients with NETLM of G2 accounted for 81%(25/31), and 94%(29/31) of non-functional NETLM. 27 patients received preoperative medication therapy, 21 cases of preoperative transcatheter arterial embolization, and 16 cases of resection of primary lesions, respectively. The operation time, intraoperative blood loss and blood transfusion were observed. The short-term postoperative outcomes included postoperative length of hospital stay, incidence of postoperative complications and mortality rate. The long-term prognosis was progression-free survival (PFS). Kaplan-Meier survival curve was used for survival analysis.

Results

The tumor burden of liver metastases was (40±3)%, and the maximal diameter of liver metastases was 10.0(8.5, 13.5) cm. The operation time was 168 (135,235) min. The intraoperative blood loss was 800 (300,1 000) ml, and 17 cases required blood transfusion. The length of postoperative hospital stay was 6 (5,7) d. The incidence of postoperative complications was 48%(15/31), and no perioperative death was found. Postoperatively, tumor grade was increased in 6 cases. The median PFS was 12.0 (95%CI: 6.9-17.1) months. The 6-, 12- and 18-month PFS rate was 85%, 56% and 37%, respectively.

Conclusions

Cytoreductive surgery is relatively safe for NETLM patients, which can obtain favorable survival benefits and provide guidance for subsequent treatment.

Key words: Neuroendocrine tumor, Liver metastasis, Debulking operation, Progression-free survival, Prognosis

图1 一例NETLM外科减瘤术前术后影像学检查及术中图像注：a、b、c为术前增强CT，示肝内多发转移灶；d、e为术后增强MRI复查，示减瘤大部分病灶，剩余肝脏代偿增大；f为术后肝脏断面；NETLM为神经内分泌肿瘤肝转移

图2 NETLM患者外科减瘤术后Kaplan-Meier生存曲线注：NETLM为神经内分泌肿瘤肝转移

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Safety and efficacy of cytoreductive surgery in neuroendocrine tumor liver metastases

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Safety and efficacy of cytoreductive surgery in neuroendocrine tumor liver metastases