Surgery with Radical Intent: Is There an Indication for G3 Neuroendocrine Neoplasms?
- 92 Downloads
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.
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.
Surgery with radical intent might represent a valid option for GEP-NEN G3 patients with locoregional disease, especially with Ki67 value ≤ 55%.
The study was endorsed by unrestricted support from the Ipsen Scientific Exchange Program (2016–2018).
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.
- 7.Klöppel G et al. WHO classification of tumours of endocrine Organs. 4th ed., vol. 10. Lyon:WHO/IARC;2007.Google Scholar
- 8.WHO classification of Tumors Editorial Board: digestive system tumors. 5th ed;2019.Google Scholar
- 15.Yang M, Ke NW, Zeng L, et al. Survival analyses for patients with surgically resected pancreatic neuroendocrine tumors by World Health Organization 2010 Grading Classifications and American Joint Committee on Cancer 2010 Staging Systems. Medicine (Baltimore). 2015;94(48):e2156.CrossRefGoogle Scholar
- 16.Shen C, Chen H, Chen H, et al. Surgical treatment and prognosis of gastric neuroendocrine neoplasms: a single-center experience. BMC Gastroenterol. 9 2016;16:111.Google Scholar
- 17.Deng HY, Li G, Luo J, Li XR, Alai G, Lin YD. The role of surgery in treating resectable limited disease of esophageal neuroendocrine carcinoma. World J Surg. 16 2018.Google Scholar
- 21.Yoshida T, Hijioka S, Hosoda W, et al. Surgery for pancreatic neuroendocrine tumor g3 and carcinoma g3 should be considered separately. Ann Surg Oncol. 12;2019.Google Scholar
- 25.Wu L, Chen F, Chen S, Wang L. The Lymph node ratio optimizes staging in patients with small intestinal neuroendocrine tumors. Neuroendocrinology. 2018.Google Scholar