What is the prognosis of a grade 2 (Grade 2) well-differentiated neuroendocrine tumor (NET) of the pancreas with possible residual tumor and hepatic metastases after distal pancreatectomy?

From the Guidelines

The prognosis for a grade 2 neuroendocrine tumor (NET) with evidence of metastatic disease to the liver following distal pancreatectomy is guarded, with a 5-year survival rate typically ranging from 60-80% in metastatic disease. This case shows persistent disease with possible residual tumor at the surgical site (Krenning score 2) and increased uptake in multiple liver lesions (Krenning score 3), indicating progressive metastatic disease despite surgical intervention. Grade 2 NETs have moderate aggressiveness, and several factors may influence the individual prognosis, including the tumor's proliferation index (Ki-67), response to systemic therapies, and the extent of liver involvement.

Key Factors Influencing Prognosis

• Tumor's proliferation index (Ki-67)
• Response to systemic therapies
• Extent of liver involvement Treatment options would likely include somatostatin analogs, peptide receptor radionuclide therapy (PRRT), targeted therapies, or chemotherapy, as suggested by recent guidelines 1. While NETs generally grow more slowly than other cancers, the progression of liver metastases and possible residual disease at the surgical site suggest that additional treatment will be necessary to control disease progression and extend survival. The choice of treatment should be based on the tumor's growth rate, Ki-67, and the presence of somatostatin receptors, with PRRT being a viable option for SSTR-positive Pan-NETs 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Prognosis of Neuroendocrine Tumors with Liver Metastases

The prognosis of neuroendocrine tumors (NETs) with liver metastases is variable and depends on several factors, including the grade and differentiation of the tumor, the extent of liver involvement, and the presence of extrahepatic disease.

• According to 2, the liver is the most common site of metastasis for NETs, and the presence of liver metastases is a significant prognostic factor for survival.
• The study by 3 suggests that liver-directed therapies, such as transarterial embolization, chemoembolization, and radioembolization, can provide locoregional control and improve symptoms in patients with NET liver metastases.
• The review by 4 highlights the importance of a multidisciplinary approach to the management of NET liver metastases, including surgical resection, liver-directed therapies, and systemic treatments.

Treatment Options for Neuroendocrine Tumors with Liver Metastases

Several treatment options are available for patients with NETs and liver metastases, including:

• Surgical resection of the primary tumor and liver metastases, as recommended by 5 and 6
• Liver-directed therapies, such as transarterial embolization, chemoembolization, and radioembolization, as discussed in 3 and 4
• Systemic treatments, including somatostatin analogues, interferon-α, and chemotherapy, as mentioned in 2
• Peptide receptor radionuclide therapy, which has shown promise in the treatment of NETs with liver metastases, as reported in 3 and 5

Factors Influencing Prognosis

Several factors can influence the prognosis of patients with NETs and liver metastases, including:

• The grade and differentiation of the tumor, as noted in 2 and 6
• The extent of liver involvement, as discussed in 3 and 4
• The presence of extrahepatic disease, as mentioned in 2 and 5
• The patient's performance status and overall health, as highlighted in 6