Introduction: Neuroendocrine liver metastases (NELM) are a major determinant of morbidity and mortality in patients with neuroendocrine neoplasms. Over the past three decades, advances in imaging, systemic therapies, radionuclide treatment, and liver-directed interventions have expanded therapeutic options.
Introduction:
Neuroendocrine liver metastases (NELM) are a major determinant of morbidity and mortality in patients with neuroendocrine neoplasms. Over the past three decades, advances in imaging, systemic therapies, radionuclide treatment, and liver-directed interventions have expanded therapeutic options. This multicenter study evaluated how evolving management strategies have influenced long-term outcomes in patients with NELM.
Why was this study needed?
. Treatment options for NELM have expanded considerably over the past 30 years.
. The optimal sequencing and combination of available therapies remain uncertain.
. Long-term real-world data evaluating changes in management and survival are limited.
. Understanding treatment trends can inform future multidisciplinary care strategies.
Results:
This multicenter cohort included 551 patients with neuroendocrine liver metastases managed between 1990 and 2020. Most patients presented with synchronous liver metastases, and nearly three-quarters received multimodal treatment. Over time, somatostatin receptor PET/CT and MRI became the preferred imaging modalities, while the use of somatostatin analogs and peptide receptor radionuclide therapy (PRRT) increased substantially. Surgical resection rates remained relatively stable throughout the study period, reflecting its continued role within multidisciplinary management. Survival improved markedly over the three decades, with progressive gains in both 5-year and 10-year overall survival. Multivariable analysis demonstrated that multimodal treatment strategies were independently associated with significantly better overall survival, underscoring the value of combining surgical, systemic, radionuclide, and liver-directed therapies.
Clinical Impact:
The study highlights the transformation of NELM management from predominantly single-modality treatment to integrated multidisciplinary care. Advances in functional imaging and theranostic approaches, particularly PRRT, have contributed to improved patient selection and outcomes. These findings support management within specialized neuroendocrine tumor centers where individualized multimodal treatment strategies can be optimized.
Bottom Line:
Survival in neuroendocrine liver metastases has improved substantially over the past three decades, driven by advances in imaging and multimodal therapy. A multidisciplinary treatment approach is associated with the best long-term outcomes.
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