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Impact of Postoperative Chemotherapy on the Survival of Patients with High-Grade Gastroenteropancreatic Neuroendocrine Carcinoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to determine whether postoperative chemotherapy is associated with a survival benefit for patients with poorly differentiated neuroendocrine carcinoma (NEC) of the stomach, small bowel, or pancreas.

Methods

Patients were identified in the National Cancer Database (NCDB) between 2004 and 2014. Inverse probability of treatment weighting (IPTW) was used to reduce selection bias. To compare the overall survival (OS) of patients in different treatment groups, IPTW-adjusted Kaplan–Meier curves and Cox proportional hazards models were used.

Results

The inclusion criteria were met by 759 patients. The diagnosis was NEC of the stomach for 195 patients (25.7%), NEC of the small intestine for 278 patients (36.6%), and NEC of the pancreas for 286 patients (37.7%). Overall, 213 patients (28.1%) received postoperative chemotherapy after curative resection. For the patients who received chemotherapy, IPTW-adjusted survival showed no OS benefit. However, subgroup analysis demonstrated improved OS with observation (OB) for patients with NEC of the small intestine (hazard ratio [HR], 1.436; 95% confidence interval [CI] 1.13–1.823; P = 0.003), T3 or T4 primary tumor (HR, 1.258; 95% CI 1.08–1.465; P = 0.003), node-positive disease (HR, 1.238; 95% CI 1.040–1.475; P = 0.0165), or positive resection margin (HR, 1.4283; 95% CI 1.02–2.00; P = 0.038).

Conclusions

In this national database analysis, postoperative chemotherapy was not associated with improved survival for patients with poorly differentiated gastroenteropancreatic (GEP) NECs. These findings highlight the need for continued efforts to understand better which patients in this high-risk population will benefit from additional systemic therapy and the need for continued development of more effective therapies for these patients.

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Robin Schmitz MD, Dimitrios Moris MD, PhD & Dan G. Blazer III MD

  2. Department of Breast Surgery, Cancer Center and Cancer Institute, Shanghai, China

    Rui Mao MD

  3. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    John H. Strickler MD

Authors
  1. Robin Schmitz MD
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  2. Rui Mao MD
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  3. Dimitrios Moris MD, PhD
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  4. John H. Strickler MD
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  5. Dan G. Blazer III MD
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Correspondence to Robin Schmitz MD.

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Fig. S1

Baseline patient characteristics before and after inverse probability of treatment weighting (IPTW)-adjustment of the stomach, small intestine, and pancreas subgroups. (TIFF 3120 kb)

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Schmitz, R., Mao, R., Moris, D. et al. Impact of Postoperative Chemotherapy on the Survival of Patients with High-Grade Gastroenteropancreatic Neuroendocrine Carcinoma. Ann Surg Oncol 28, 114–120 (2021). https://doi.org/10.1245/s10434-020-08730-0

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  • DOI: https://doi.org/10.1245/s10434-020-08730-0

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