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Surgery with Radical Intent: Is There an Indication for G3 Neuroendocrine Neoplasms?

  • Elettra MerolaEmail author
  • Anja Rinke
  • Stefano Partelli
  • Thomas M. Gress
  • Valentina Andreasi
  • Attila Kollár
  • Aurel Perren
  • Emanuel Christ
  • Francesco Panzuto
  • Andreas Pascher
  • Henning Jann
  • Ruza Arsenic
  • Birgit Cremer
  • Daniel Kaemmerer
  • Patrizia Kump
  • Rainer W. Lipp
  • Abbas Agaimy
  • Bertram Wiedenmann
  • Massimo Falconi
  • Marianne E. Pavel
Endocrine Tumors
  • 92 Downloads

Abstract

Background

While platinum-based chemotherapy represents the standard treatment for advanced grade 3 (G3) neuroendocrine neoplasms (NENs) according to the European Neuroendocrine Tumor Society guidelines, the role of radical-intended surgery in these patients, as well as the use of adjuvant chemotherapy, are still controversial. The aim of the present work is to describe, in a retrospective series of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) G3, the overall survival (OS) rate and risk factors for death after radical surgery. Secondary aims are the description of median recurrence-free survival (RFS) and of the role of adjuvant chemotherapy.

Patients and Methods

Multicenter analysis of a series of stage I–III GEP-NEN G3 patients receiving radical surgery (R0/R1) with/without adjuvant chemotherapy was performed.

Results

Sixty patients from eight neuroendocrine tumor (NET) referral centers, with median follow-up of 23 months (5–187 months) were evaluated. While 28.6% of cases had NET G3, 71.4% had neuroendocrine carcinoma G3 (NEC G3). The 2-year OS rate after radical surgery was 64.5%, with a statistically significant difference in terms of Ki67 threshold (cut-off 55%, P = 0.03) and tumor differentiation (NEC G3 vs. NET G3, P = 0.03). Median RFS after radical surgery was 14 months, and 2-year RFS rate was 44.9%. Use of adjuvant chemotherapy provided no benefit in terms of either OS or RFS in this series.

Conclusions

Surgery with radical intent might represent a valid option for GEP-NEN G3 patients with locoregional disease, especially with Ki67 value ≤ 55%.

Notes

Acknowledgements

The study was endorsed by unrestricted support from the Ipsen Scientific Exchange Program (2016–2018).

Disclosures

The study was supported by the European Neuroendocrine Tumor Society (ENETS) “Excellence Academy Fellowship Grant” (2017). Dr. Anja Rinke declared: honoraria for presentations and attendance of advisory boards from Novartis and IPSEN; coverage of travel costs/congress costs from IPSEN; Notice: As this manuscript is about surgery there is no connection of the content with drug treatment/drug companies, and therefore no conflict of interest to the content of this manuscript. All other authors have no conflicts of interest to declare.

Supplementary material

10434_2019_8049_MOESM1_ESM.doc (36 kb)
Supplementary material 1 (DOC 37 kb)
10434_2019_8049_MOESM2_ESM.doc (42 kb)
Supplementary material 2 (DOC 43 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Elettra Merola
    • 1
    • 2
    • 3
    Email author
  • Anja Rinke
    • 4
  • Stefano Partelli
    • 5
  • Thomas M. Gress
    • 4
  • Valentina Andreasi
    • 5
  • Attila Kollár
    • 6
  • Aurel Perren
    • 7
  • Emanuel Christ
    • 8
  • Francesco Panzuto
    • 3
  • Andreas Pascher
    • 9
    • 10
  • Henning Jann
    • 11
  • Ruza Arsenic
    • 12
  • Birgit Cremer
    • 13
  • Daniel Kaemmerer
    • 14
  • Patrizia Kump
    • 15
  • Rainer W. Lipp
    • 16
  • Abbas Agaimy
    • 17
  • Bertram Wiedenmann
    • 11
  • Massimo Falconi
    • 5
  • Marianne E. Pavel
    • 2
    • 11
  1. 1.Department of GastroenterologyAzienda Provinciale per i Servizi Sanitari (APSS)TrentoItaly
  2. 2.Department of Medicine 1, Division of EndocrinologyFriedrich-Alexander University Erlangen-NurembergErlangenGermany
  3. 3.Digestive and Liver Diseases UnitSant’Andrea HospitalRomeItaly
  4. 4.Department of Gastroenterology, Endocrinology, Metabolism and InfectiologyUniversity Hospital Marburg and Philipps University MarburgMarburgGermany
  5. 5.Pancreatic Surgery UnitVita-Salute University, San Raffaele Hospital IRCCSMilanItaly
  6. 6.Department of Medical Oncology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
  7. 7.Institute of PathologyUniversity of BernBernSwitzerland
  8. 8.Department of Endocrinology, Diabetology and Metabolism, Center of Endocrine and Neuroendocrine TumorsUniversity Hospital of BaselBaselSwitzerland
  9. 9.Klinik für Allgemein-, Viszeral- und TransplantationschirurgieUniversitätsklinikum MünsterMünsterGermany
  10. 10.Department of SurgeryCharité UniversitätsmedizinBerlinGermany
  11. 11.Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus MitteCharité UniversitätsmedizinBerlinGermany
  12. 12.Department of Pathology, Campus MitteCharité UniversitätsmedizinBerlinGermany
  13. 13.Department of Internal Medicine I, Center for Integrated Oncology Cologne/BonnUniversity Hospital of CologneCologneGermany
  14. 14.Department of General and Visceral SurgeryZentralklinik Bad BerkaBad BerkaGermany
  15. 15.Division of Gastroenterology and Hepatology, Department of Internal MedicineMedical UniversityGrazAustria
  16. 16.Division of Oncology, Department of Internal MedicineMedical UniversityGrazAustria
  17. 17.Institute of PathologyFriedrich-Alexander University Erlangen-Nuremberg, University HospitalErlangenGermany

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