A retrospective analysis of TACE-based multimodal liver-directed therapy for unresectable gastroenteropancreatic neuroendocrine carcinoma with liver metastases.
- 1Department of Interventional Therapy, Peking University Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China.
- 2Department of Gastroenterological Oncology, Peking University Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China.
Abstract
Transarterial chemoembolization (TACE) is widely used for liver metastases from well-differentiated neuroendocrine tumors, which are typically hypervascular. In contrast, gastroenteropancreatic neuroendocrine carcinoma liver metastases (GEP-NECLM) may be less hypervascular, raising uncertainty regarding the role of embolization-based therapy in this population. Nevertheless, TACE has also demonstrated antitumor activity in relatively hypovascular liver metastases, such as colorectal liver metastases. In clinical practice, TACE may also be combined with hepatic arterial infusion chemotherapy (HAIC) as part of a multimodal liver-directed strategy. We therefore hypothesized that TACE-based multimodal liver-directed therapy could provide intrahepatic antitumor activity in patients with unresectable GEP-NECLM and aimed to evaluate its efficacy, safety, and prognostic factors. Patients with unresectable GEP-NECLM who underwent TACE-based multimodal liver-directed therapy between February 2012 and June 2024 were retrospectively reviewed. Pathological diagnoses were reassessed according to the 2019 World Health Organization classification. The primary endpoint was overall survival (OS), defined as the time from the first TACE session to death from any cause. Secondary endpoints included progression-free survival (PFS), defined as the time from the first TACE session to progressive disease in any organ or all-cause mortality; hepatic progression-free survival (hPFS), defined as the time from the first TACE session to intrahepatic disease progression or all-cause mortality; objective response rate (ORR), disease control rate (DCR), and safety. A total of 34 patients were included; 24 (70.6%) received TACE in combination with HAIC, and 29 (85.3%) had received at least one line of prior systemic therapy. The ORR and DCR were 41.2% and 76.5%, respectively. After a median follow-up of 45.1 months, the median PFS was 4.4 months, the median hPFS was 5.5 months and the median OS was 10.8 months. Colorectal primary site was independently associated with shorter PFS, with a hazard ratio (HR) of 3.189 (P=0.01). Ki-67 proliferation index (Ki-67) ≥55% (HR =6.172; P=0.006) was independently associated with worse OS. A total of 34 patients underwent 60 interventional treatment sessions. The treatment showed an acceptable safety profile, with no 30-day mortality or hepatic decompensation. Post-embolization syndrome was the most common treatment-emergent adverse event, occurring in 32 of 60 sessions (53.3%). All adverse events were manageable with symptomatic treatment. TACE-based multimodal liver-directed therapy was associated with measurable intrahepatic antitumor activity and an acceptable safety profile in patients with unresectable GEP-NECLM. Colorectal primary site was independently associated with shorter PFS, whereas a Ki-67 ≥55% was independently associated with worse OS. These findings require further validation in larger prospective studies.
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BibTeX
@article{luo2026retrospective,
title = {{A retrospective analysis of TACE-based multimodal liver-directed therapy for unresectable gastroenteropancreatic neuroendocrine carcinoma with liver metastases.}},
author = {Siyi Luo and Baojiang Liu and Aiwei Feng and Peng Liu and Fuxin Kou and Guang Cao and Song Gao and Jianhai Guo and Xin Zhang and Xiaodong Wang and Hui Chen and Haifeng Xu and Qinzong Gao and Jie Li and Xu Zhu},
journal = {Translational cancer research},
year = {2026},
month = sep,
doi = {10.21037/tcr-2026-1896},
url = {https://europepmc.org/article/MED/42997711},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A retrospective analysis of TACE-based multimodal liver-directed therapy for unresectable gastroenteropancreatic neuroendocrine carcinoma with liver metastases.
AU - Siyi Luo
AU - Baojiang Liu
AU - Aiwei Feng
AU - Peng Liu
AU - Fuxin Kou
AU - Guang Cao
AU - Song Gao
AU - Jianhai Guo
AU - Xin Zhang
AU - Xiaodong Wang
AU - Hui Chen
AU - Haifeng Xu
AU - Qinzong Gao
AU - Jie Li
AU - Xu Zhu
PY - 2026
DA - 2026/09/28
JO - Translational cancer research
DO - 10.21037/tcr-2026-1896
UR - https://europepmc.org/article/MED/42997711
AB - Transarterial chemoembolization (TACE) is widely used for liver metastases from well-differentiated neuroendocrine tumors, which are typically hypervascular. In contrast, gastroenteropancreatic neuroendocrine carcinoma liver metastases (GEP-NECLM) may be less hypervascular, raising uncertainty regarding the role of embolization-based therapy in this population. Nevertheless, TACE has also demonstrated antitumor activity in relatively hypovascular liver metastases, such as colorectal liver metastases. In clinical practice, TACE may also be combined with hepatic arterial infusion chemotherapy (HAIC) as part of a multimodal liver-directed strategy. We therefore hypothesized that TACE-based multimodal liver-directed therapy could provide intrahepatic antitumor activity in patients with unresectable GEP-NECLM and aimed to evaluate its efficacy, safety, and prognostic factors. Patients with unresectable GEP-NECLM who underwent TACE-based multimodal liver-directed therapy between February 2012 and June 2024 were retrospectively reviewed. Pathological diagnoses were reassessed according to the 2019 World Health Organization classification. The primary endpoint was overall survival (OS), defined as the time from the first TACE session to death from any cause. Secondary endpoints included progression-free survival (PFS), defined as the time from the first TACE session to progressive disease in any organ or all-cause mortality; hepatic progression-free survival (hPFS), defined as the time from the first TACE session to intrahepatic disease progression or all-cause mortality; objective response rate (ORR), disease control rate (DCR), and safety. A total of 34 patients were included; 24 (70.6%) received TACE in combination with HAIC, and 29 (85.3%) had received at least one line of prior systemic therapy. The ORR and DCR were 41.2% and 76.5%, respectively. After a median follow-up of 45.1 months, the median PFS was 4.4 months, the median hPFS was 5.5 months and the median OS was 10.8 months. Colorectal primary site was independently associated with shorter PFS, with a hazard ratio (HR) of 3.189 (P=0.01). Ki-67 proliferation index (Ki-67) ≥55% (HR =6.172; P=0.006) was independently associated with worse OS. A total of 34 patients underwent 60 interventional treatment sessions. The treatment showed an acceptable safety profile, with no 30-day mortality or hepatic decompensation. Post-embolization syndrome was the most common treatment-emergent adverse event, occurring in 32 of 60 sessions (53.3%). All adverse events were manageable with symptomatic treatment. TACE-based multimodal liver-directed therapy was associated with measurable intrahepatic antitumor activity and an acceptable safety profile in patients with unresectable GEP-NECLM. Colorectal primary site was independently associated with shorter PFS, whereas a Ki-67 ≥55% was independently associated with worse OS. These findings require further validation in larger prospective studies.
SN - 2218-676X
SN - 2219-6803
ER -