随着肽受体放射性核素治疗的出现，转移性胃肠胰神经内分泌肿瘤的手术时机和顺序值得进一步研究。我们假设肽受体放射性核素治疗前进行手术可能会增强转移性胃肠胰神经内分泌肿瘤患者的疗效。纳入2018年至2023年间接受177镥点肽受体放射性核素治疗的89例转移性高分化胃肠胰腺神经内分泌肿瘤患者。 56 名患者在肽受体放射性核素治疗前接受了手术（原发性肿瘤切除和/或肝脏减灭术），33 名患者没有接受手术。主要结局是根据实体瘤疗效评估标准的无进展生存期。治疗前采用 dotatate 正电子发射断层扫描/计算机断层扫描计算肿瘤体积。手术组和非手术组匹配良好。肽受体放射性核素治疗后，非手术组的中位无进展生存期为 15.6 个月（四分位距，9.1-22.7 个月），而手术组为 26.1 个月（四分位距，12.7-38.1 个月）（P = .04） ）。亚组分析显示，仅接受原发肿瘤切除术的患者的中位无进展生存期为 18.1 个月（四分位距，11.9-38.4 个月），而接受肝脏减灭术的患者的中位无进展生存期为 26.2 个月（四分位距，14.0-38.1 个月）（P = .04)。与未接受手术的患者（中位数 626.42 mL3）相比，接受肝脏减灭术的患者肿瘤体积最低（中位数 146.07 mL3）（P = .001）。在单变量分析中，肿瘤体积 <138.8 mL3 与较长的无进展生存期相关（风险比，2.03；95% 置信区间，0.95-4.34，P = 0.05），中位无进展生存期为 38.1 个月（四分位距，16.9-41.3 个月）与 17.8 个月（四分位距，10.8-28.7 个月）相比。手术可能会增强 177 点镥治疗转移性高分化胃肠胰腺神经内分泌肿瘤的疗效。这种积极的效果可能是手术后患者肿瘤体积较小的结果。我们的研究结果强化了使用手术减灭术来改善全身疗法（例如肽受体放射性核素疗法）的概念。版权所有 © 2024 Elsevier Inc. 保留所有权利。

With the advent of peptide receptor radionuclide therapy, the timing and sequence of surgery in the treatment of metastatic gastroenteropancreatic neuroendocrine tumors merits further study. We hypothesized that surgery before peptide receptor radionuclide therapy might enhance its effectiveness in patients with metastatic gastroenteropancreatic neuroendocrine tumors.Eighty-nine patients with metastatic well-differentiated gastroenteropancreatic neuroendocrine tumors treated with 177Lutetium-dotatate peptide receptor radionuclide therapy between 2018 and 2023 were included. Fifty-six patients underwent surgery (primary tumor resection and/or liver debulking) before peptide receptor radionuclide therapy and 33 patients did not. Primary outcome was progression-free survival according to Response Evaluation Criteria in Solid Tumors. Pretreatment dotatate positron emission tomography/computed tomography was used to calculate tumor volumes.The surgery and no-surgery groups were well-matched. Median progression-free survival after peptide receptor radionuclide therapy was 15.6 months (interquartile range, 9.1-22.7 months) in the no-surgery group compared with 26.1 months (interquartile range, 12.7-38.1 months) in the surgery group (P = .04). On subgroup analysis, median progression-free survival was 18.1 months (interquartile range, 11.9-38.4 months) in patients who underwent primary tumor resection only compared with 26.2 months (interquartile range, 14.0-38.1 months) in patients who underwent liver debulking (P = .04). Tumor volume was lowest in patients who underwent liver debulking (median 146.07 mL3) compared with no surgery (median 626.42 mL3) (P = .001). On univariable analysis, a tumor volume <138.8 mL3 was associated with longer progression-free survival (hazard ratio, 2.03; 95% confidence interval, 0.95-4.34, P = .05), with a median progression-free survival of 38.1 months (interquartile range, 16.9-41.3 months) compared with 17.8 months (interquartile range, 10.8-28.7 months).Surgery may enhance the effectiveness of 177Lutetium-dotatate in the treatment of metastatic well-differentiated gastroenteropancreatic neuroendocrine tumors. This positive effect may be the result of a lower tumor volume in patients after surgery. Our findings fortify the concept of using surgical debulking to improve systemic therapies such as peptide receptor radionuclide therapy.Copyright © 2024 Elsevier Inc. All rights reserved.