PURPOSE: The American Joint Committee on Cancer (AJCC) staging manual has introduced a TNM staging classification for jejunal-ileal (midgut) neuroendocrine tumors (NETs). This classification has not been validated in a population consisting solely of midgut NETs. The purpose of this study was to test the prognostic validity of the classification in such a population. METHODS: Patients with jejunal and ileocecal NETs who were treated at the Moffitt Cancer Center between 2000 and 2010 were assigned stages (I through IV). Kaplan-Meier analyses for overall survival (OS) were performed on the basis of TNM stage and pathologic grade. Multivariate modeling was performed using Cox proportional hazards regression. RESULTS: We identified 691 patients with jejunal-ileocecal NETs. The AJCC classification in aggregate was highly prognostic for OS (P < .001). Five-year OS rates for stages I through IV were 100%, 100%, 91%, and 72%, respectively. The survival difference between stages III and IV was significant (P < .001); the difference between stages I/II versus III was not statistically significant (P = .1). Among patients with stage IIIB tumors, 5-year survival rates were 95% for resectable tumors versus 78% for unresectable mesenteric tumors (P = .02). A proliferative threshold of five mitoses per 10 high-power fields (HPF) was of greater prognostic value than a threshold of two mitoses per 10 HPF for discriminating between low- and intermediate-grade tumors. CONCLUSION: Stage I and II midgut NETs are associated with identical survival rates. Stage IIIB tumors are heterogeneous, with significant differences in survival observed between resectable mesenteric lymph nodes versus unresectable masses in the root of the mesentery. A higher mitotic cutoff of five per 10 HPF may lead to improved prognostic differentiation between low- and intermediate-grade tumors. Revisions to the current AJCC staging and grading classification may be warranted.
PURPOSE: The American Joint Committee on Cancer (AJCC) staging manual has introduced a TNM staging classification for jejunal-ileal (midgut) neuroendocrine tumors (NETs). This classification has not been validated in a population consisting solely of midgut NETs. The purpose of this study was to test the prognostic validity of the classification in such a population. METHODS:Patients with jejunal and ileocecal NETs who were treated at the Moffitt Cancer Center between 2000 and 2010 were assigned stages (I through IV). Kaplan-Meier analyses for overall survival (OS) were performed on the basis of TNM stage and pathologic grade. Multivariate modeling was performed using Cox proportional hazards regression. RESULTS: We identified 691 patients with jejunal-ileocecal NETs. The AJCC classification in aggregate was highly prognostic for OS (P < .001). Five-year OS rates for stages I through IV were 100%, 100%, 91%, and 72%, respectively. The survival difference between stages III and IV was significant (P < .001); the difference between stages I/II versus III was not statistically significant (P = .1). Among patients with stage IIIB tumors, 5-year survival rates were 95% for resectable tumors versus 78% for unresectable mesenteric tumors (P = .02). A proliferative threshold of five mitoses per 10 high-power fields (HPF) was of greater prognostic value than a threshold of two mitoses per 10 HPF for discriminating between low- and intermediate-grade tumors. CONCLUSION: Stage I and II midgut NETs are associated with identical survival rates. Stage IIIB tumors are heterogeneous, with significant differences in survival observed between resectable mesenteric lymph nodes versus unresectable masses in the root of the mesentery. A higher mitotic cutoff of five per 10 HPF may lead to improved prognostic differentiation between low- and intermediate-grade tumors. Revisions to the current AJCC staging and grading classification may be warranted.
Authors: David A Kleiman; Toni Beninato; Samuel Sultan; Michael J P Crowley; Brendan Finnerty; Ritu Kumar; Nicole C Panarelli; Yi-Fang Liu; Michael D Lieberman; Marco Seandel; Todd Evans; Olivier Elemento; Rasa Zarnegar; Thomas J Fahey Journal: Ann Surg Oncol Date: 2014-05-23 Impact factor: 5.344
Authors: Jonathan Strosberg; Ghassan El-Haddad; Edward Wolin; Andrew Hendifar; James Yao; Beth Chasen; Erik Mittra; Pamela L Kunz; Matthew H Kulke; Heather Jacene; David Bushnell; Thomas M O'Dorisio; Richard P Baum; Harshad R Kulkarni; Martyn Caplin; Rachida Lebtahi; Timothy Hobday; Ebrahim Delpassand; Eric Van Cutsem; Al Benson; Rajaventhan Srirajaskanthan; Marianne Pavel; Jaime Mora; Jordan Berlin; Enrique Grande; Nicholas Reed; Ettore Seregni; Kjell Öberg; Maribel Lopera Sierra; Paola Santoro; Thomas Thevenet; Jack L Erion; Philippe Ruszniewski; Dik Kwekkeboom; Eric Krenning Journal: N Engl J Med Date: 2017-01-12 Impact factor: 91.245
Authors: Michelle Kang Kim; Richard R P Warner; Sasan Roayaie; Noam Harpaz; Stephen C Ward; Steven Itzkowitz; Juan P Wisnivesky Journal: J Clin Oncol Date: 2013-09-16 Impact factor: 44.544