Andrew Hanna1, Caroline Kim-Kiselak2, Rebecca Tang3, David C Metz4, Zhaohai Yang5, Ronald DeMatteo6, Douglas L Fraker6, Robert E Roses6. 1. Department of General Surgery, University of Pennsylvania, Philadelphia, PA, USA. andrewnhanna4@gmail.com. 2. University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 3. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. 4. Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 5. Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA. 6. Department of General Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: Type I gastric neuroendocrine tumors (GNETs) are typically managed either expectantly or endoscopically. In contrast, locoregional surgery has been recommended for patients with type III GNETs because of the risk of metastasis. This study aimed to identify predictors of outcome independent of type in a contemporary cohort of GNET patients. METHODS: A single-institution retrospective cohort study of 121 patients with a pathologic diagnosis of primary GNET between January 2009 and June 2019 was performed. GNETs were designated as type 1 (n = 74) if atrophic gastritis was present, or as type III (n = 47) in the absence of atrophic gastritis. Demographic, clinical, and histopathologic factors were examined using Kaplan-Meier and multivariable Cox regression to assess the impact of various factors on recurrence and overall survival. RESULTS: Median follow-up for the entire cohort was 62.7 months. While there was no difference in OS in patients with different GNET types (p = 0.10), higher tumor grade (p = 0.02) and presence of nodal or distant metastases (p = 0.02) predicted worse survival on multivariable analysis. Among type III GNET patients, those with small (< 0.5 cm), grade 1 lesions ("low-risk") were less likely to develop metastases (0% versus 33%, p < 0.01) and more likely to survive (100% versus 67%, p < 0.01) at 5 years. CONCLUSIONS: Size and tumor grade predict recurrence and survival in patients with GNETs irrespective of type. Small, low-grade type III GNETs are associated with minimal risk of progression and may be managed accordingly.
BACKGROUND: Type I gastric neuroendocrine tumors (GNETs) are typically managed either expectantly or endoscopically. In contrast, locoregional surgery has been recommended for patients with type III GNETs because of the risk of metastasis. This study aimed to identify predictors of outcome independent of type in a contemporary cohort of GNET patients. METHODS: A single-institution retrospective cohort study of 121 patients with a pathologic diagnosis of primary GNET between January 2009 and June 2019 was performed. GNETs were designated as type 1 (n = 74) if atrophic gastritis was present, or as type III (n = 47) in the absence of atrophic gastritis. Demographic, clinical, and histopathologic factors were examined using Kaplan-Meier and multivariable Cox regression to assess the impact of various factors on recurrence and overall survival. RESULTS: Median follow-up for the entire cohort was 62.7 months. While there was no difference in OS in patients with different GNET types (p = 0.10), higher tumor grade (p = 0.02) and presence of nodal or distant metastases (p = 0.02) predicted worse survival on multivariable analysis. Among type III GNET patients, those with small (< 0.5 cm), grade 1 lesions ("low-risk") were less likely to develop metastases (0% versus 33%, p < 0.01) and more likely to survive (100% versus 67%, p < 0.01) at 5 years. CONCLUSIONS: Size and tumor grade predict recurrence and survival in patients with GNETs irrespective of type. Small, low-grade type III GNETs are associated with minimal risk of progression and may be managed accordingly.
Authors: Ben Lawrence; Bjorn I Gustafsson; Anthony Chan; Bernhard Svejda; Mark Kidd; Irvin M Modlin Journal: Endocrinol Metab Clin North Am Date: 2011-03 Impact factor: 4.741
Authors: G Rindi; C Azzoni; S La Rosa; C Klersy; D Paolotti; S Rappel; M Stolte; C Capella; C Bordi; E Solcia Journal: Gastroenterology Date: 1999-03 Impact factor: 22.682