G. Spolverato1, A. Vitale1, A. Ejaz1, Y. Kim1, J. Geschwind1, C. Wolfgang1, M. Weiss1, T. M. Pawlik1 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA
Introduction: Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to compare the survival benefit of hepatic resection (HR) versus intra-arterial therapy (IAT) among patients with NELM.
Methods: A decision analytic Markov model was created to estimate and compare life expectancy associated with different management strategies (HR vs. IAT) for a simulated cohort of patients with NELM. The primary (base-case) analysis was calculated based on a 57-year old male patient with metachronous, symptomatic NELM that involved < 25% of the liver in the absence of extrahepatic disease. A Monte Carlo simulation was performed to assess the effect on outcomes with variation in model/disease parameters.
Results: In the base-case analysis, HR was strongly favored over IAT providing a survival benefit of 52 months. On the Monte Carlo simulation, the greatest survival benefit for HR was among patients with a smaller volume of disease (<25%) and functioning/symptomatic NELM. While patients with large volume symptomatic disease (≥ 25%) benefited from HR over IAT, the effect was less pronounced (34 months). In contrast, patients with large volume non-functioning/asymptomatic NELM did not seemingly derive a benefit from HR; instead, this cohort of patients had an anticipated 23 months better survival with IAT rather than HR.
Conclusion: A Markov decision model demonstrated that HR was the preferred strategy among patients with symptomatic NELM, regardless of hepatic disease burden. In contrast, IAT was associated with better outcomes among patients with large volume disease, especially among those patients with non-functioning/asymptomatic NELM.