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Is There a Role for Surgery in Patients with Neuroendocrine Tumors of the Esophagus? A Contemporary View from the NCDB

  • Suna Erdem
  • Esther Troxler
  • René Warschkow
  • Catherine Tsai
  • Babatunde Yerokun
  • Bruno Schmied
  • Christoph Stettler
  • Dan G. BlazerIII
  • Matthew Hartwig
  • Mathias WorniEmail author
  • Beat Gloor
Thoracic Oncology

Abstract

Background

Esophageal neuroendocrine tumors (eNETs) are exceedingly rare, aggressive and have a poor prognosis. Treatment guidelines are ill-defined and mainly based on evidence from case reports and analogous experiences drawn from similar disease sites.

Methods

The NCDB was reviewed for histologically confirmed stage I–III, primary eNETs from 2006 to 2014. Patients were grouped into whether or not they underwent primary tumor resection. Univariate, multivariable, and full bipartite propensity score (PS) adjusted Cox regression analyses were used to assess overall and relative survival differences.

Results

A total of 250 patients were identified. Mean age was 65.0 (standard deviation [SD] 11.9) years, and 174 (69.6%) patients were male. Most patients had stage III disease (n = 136, 54.4%), and the most common type of NET was small cell eNET (n = 111, 44.4%). Chemotherapy was used in 186 (74.4%), radiation therapy in 178 (71.2%), and oncological resection was performed in 69 (27.6%) patients. Crude 2-year survival rates were higher in the operated (57.3%) compared with the nonoperated group (35.2%; p < 0.001). The survival benefit held true after multivariable adjustment (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.32–0.69, p < 0.001). After full bipartite PS adjustment analysis, survival was longer for patients who received a surgical resection compared with those who did not (HR 0.48, 95% CI 0.31–0.75, p = 0.003) with a corresponding 2-year overall survival rate of 63.3% (95% CI 52.0–77.2) versus 38.8% (95% CI 30.9–48.8), respectively.

Conclusions

Multimodal treatment that includes surgery is associated with better overall survival for eNETs. Additional research is needed to more definitively identify patients who benefit from esophagectomy and to establish an appropriate treatment algorithm.

Notes

Acknowledgment

The authors thank the American College of Surgeons and the American Cancer Society for providing patient information through the NCDB used for this investigation. Furthermore, we thank the patients whose information through the NCDB allowed us to perform the investigation for this manuscript.

Disclosure

The author declares that they have no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Suna Erdem
    • 1
  • Esther Troxler
    • 1
  • René Warschkow
    • 2
  • Catherine Tsai
    • 1
  • Babatunde Yerokun
    • 3
  • Bruno Schmied
    • 2
  • Christoph Stettler
    • 4
  • Dan G. BlazerIII
    • 3
  • Matthew Hartwig
    • 3
  • Mathias Worni
    • 3
    • 5
    Email author
  • Beat Gloor
    • 1
  1. 1.Department of Visceral Surgery and Medicine, InselspitalUniversity of BernBernSwitzerland
  2. 2.Department of SurgeryKantonsspital St. GallenSt. GallenSwitzerland
  3. 3.Duke University Medical CenterDurhamUSA
  4. 4.Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, InselspitalUniversity of BernBernSwitzerland
  5. 5.Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver DiseasesSt. Clara Hospital and University Hospital BaselBaselSwitzerland

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