Limits...
Surgical treatment and prognosis of gastric neuroendocrine neoplasms: a single-center experience

View Article: PubMed Central - PubMed

ABSTRACT

Background: Gastric neuroendocrine neoplasms (G-NENs) are uncommon, and data on their management is limited. We here investigated the clinicopathological characteristics, surgical and survival outcomes in G-NENs among Chinese. Moreover, we will discuss their prognostic value.

Methods: From existing databases of the West China Hospital, we retrospectively identified 135 consecutive patients who were surgically treated and pathologically diagnosed as G-NENs from January 2009 to August 2015.

Results: This entire cohort comprised 98 males and 37 females, with a median age of 60 years. Twenty-five patients underwent endoscopic resection, while 110 patients underwent open/laparoscopic surgery. Thirty-nine patients had neuroendocrine tumor G1 (NET G1), seven patients had neuroendocrine tumor G2 (NET G2), 69 patients had neuroendocrine carcinoma G3 (NEC G3) and 20 patients had mixed adenoneuroendocrine carcinoma (MANEC). The median survival was not achieved for both NET G1 and NET G2 versus 19 months (range 3–48) for NEC G3 and 10.5 months (range 3–45) for MANEC. The 3-year survival rates for stage I, II, III, and IV were 91.1 %, 78.6 %, 51.1 % and 11.8 %, respectively (P < 0.001). As for the prognostic analysis, both surgical margin and the newly updated World Health Organization (WHO) classification were independent predictors of overall survival (OS).

Conclusions: G-NENs are a kind of rare tumors, and patients with NET G3 and MANEC have unfavorable prognosis even surgically treated. Moreover, surgical margin and the new 2010 WHO criteria are closely associated with OS for G-NENs.

No MeSH data available.


Comparison of survival in all patients with G-NENs of different surgical margins
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC5016962&req=5

Fig3: Comparison of survival in all patients with G-NENs of different surgical margins

Mentions: With a median follow-up duration of 22 months (range, 2-81months), 52 patients died for the entire cohort. The main causes of the death were tumor related (76.9 %) and others (23.1 %, including respiratory failure, decompensated cirrhosis, stroke, and lung cancer). The OS rate for the entire cohort was 82.4 %, 59.0 % and 44.2 % at 1, 3 and 5 years, respectively. The 3-year OS for endoscopic resection was 92.9 %, while 51.4 % for open/laparoscopic surgery (P = 0.001). No significant difference was observed in survival between patients with and without chemotherapy (P = 0.758), as well as those between small cell and large cell type (P = 0.933). The subgroup patients with more advanced disease (NEC and MANEC) showed that these patients with chemotherapy had no survival benefit in comparison to those without chemotherapy (P = 0.730). The median survival was not achieved for both NET G1 and NET G2 versus 22.5 months (range 2–76) for NEC G3 and 12.5 months (range 3–45) for MANEC in patients with R0 resection. In those patients who underwent R0 resection, the NET G1 showed significant better OS compared with that of NEC G3 and MANEC (P < 0.001, and P < 0.001, respectively), but did not differ between NET G1 and NET G2 (P = 0.162, Fig. 1), as well as those between NEC G3 and MANEC (P = 0.102). The 3-year survival rate for the patients stratified by TNM stages I, II, III, and IV were 91.1 %, 78.6 %, 51.1 % and 11.8 %, respectively (P < 0.001, Fig. 2). The subgroups of patients with stage I and II obtained better OS than those in stage III and IV, respectively (I vs III, P < 0.001; I vs IV, P < 0.001; II vs III, P = 0.036; II vs IV, P < 0.001), as well as that between stage III and IV (P < 0.001), while no notable differences were found between stage I and II (P = 0.692). Moreover, we have found that patients who underwent R0 resection had better OS than that of R1/R2 resection (P < 0.001, Fig. 3), as well as females had greater prognosis than males (P = 0.029). OS was significantly greater in patients with lesion diameter ≤4 cm, NLR ≤2.8, and number of positive lymph node ≤4 (lesion diameter ≤4 cm vs >4 cm, P < 0.001; NLR ≤2.8 vs >2.8, P = 0.011; number of positive lymph node ≤4 vs >4, P < 0.001). The types of surgery, depth of invasion, lymph node metastasis, number of positive lymph node, distant metastasis, TNM stage, co-morbidity, surgical margin and the new 2010 WHO classification were significant factors of the prognosis for patients with G-NENs in the univariate analysis (P < 0.05). When coming into the multivariate analysis, only surgical margin and the new 2010 WHO classification were significant. The univariate and multivariate analyses by Cox regression model are listed in Table 4.Fig. 1


Surgical treatment and prognosis of gastric neuroendocrine neoplasms: a single-center experience
Comparison of survival in all patients with G-NENs of different surgical margins
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5016962&req=5

Fig3: Comparison of survival in all patients with G-NENs of different surgical margins
Mentions: With a median follow-up duration of 22 months (range, 2-81months), 52 patients died for the entire cohort. The main causes of the death were tumor related (76.9 %) and others (23.1 %, including respiratory failure, decompensated cirrhosis, stroke, and lung cancer). The OS rate for the entire cohort was 82.4 %, 59.0 % and 44.2 % at 1, 3 and 5 years, respectively. The 3-year OS for endoscopic resection was 92.9 %, while 51.4 % for open/laparoscopic surgery (P = 0.001). No significant difference was observed in survival between patients with and without chemotherapy (P = 0.758), as well as those between small cell and large cell type (P = 0.933). The subgroup patients with more advanced disease (NEC and MANEC) showed that these patients with chemotherapy had no survival benefit in comparison to those without chemotherapy (P = 0.730). The median survival was not achieved for both NET G1 and NET G2 versus 22.5 months (range 2–76) for NEC G3 and 12.5 months (range 3–45) for MANEC in patients with R0 resection. In those patients who underwent R0 resection, the NET G1 showed significant better OS compared with that of NEC G3 and MANEC (P < 0.001, and P < 0.001, respectively), but did not differ between NET G1 and NET G2 (P = 0.162, Fig. 1), as well as those between NEC G3 and MANEC (P = 0.102). The 3-year survival rate for the patients stratified by TNM stages I, II, III, and IV were 91.1 %, 78.6 %, 51.1 % and 11.8 %, respectively (P < 0.001, Fig. 2). The subgroups of patients with stage I and II obtained better OS than those in stage III and IV, respectively (I vs III, P < 0.001; I vs IV, P < 0.001; II vs III, P = 0.036; II vs IV, P < 0.001), as well as that between stage III and IV (P < 0.001), while no notable differences were found between stage I and II (P = 0.692). Moreover, we have found that patients who underwent R0 resection had better OS than that of R1/R2 resection (P < 0.001, Fig. 3), as well as females had greater prognosis than males (P = 0.029). OS was significantly greater in patients with lesion diameter ≤4 cm, NLR ≤2.8, and number of positive lymph node ≤4 (lesion diameter ≤4 cm vs >4 cm, P < 0.001; NLR ≤2.8 vs >2.8, P = 0.011; number of positive lymph node ≤4 vs >4, P < 0.001). The types of surgery, depth of invasion, lymph node metastasis, number of positive lymph node, distant metastasis, TNM stage, co-morbidity, surgical margin and the new 2010 WHO classification were significant factors of the prognosis for patients with G-NENs in the univariate analysis (P < 0.05). When coming into the multivariate analysis, only surgical margin and the new 2010 WHO classification were significant. The univariate and multivariate analyses by Cox regression model are listed in Table 4.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Gastric neuroendocrine neoplasms (G-NENs) are uncommon, and data on their management is limited. We here investigated the clinicopathological characteristics, surgical and survival outcomes in G-NENs among Chinese. Moreover, we will discuss their prognostic value.

Methods: From existing databases of the West China Hospital, we retrospectively identified 135 consecutive patients who were surgically treated and pathologically diagnosed as G-NENs from January 2009 to August 2015.

Results: This entire cohort comprised 98 males and 37 females, with a median age of 60&nbsp;years. Twenty-five patients underwent endoscopic resection, while 110 patients underwent open/laparoscopic surgery. Thirty-nine patients had neuroendocrine tumor G1 (NET G1), seven patients had neuroendocrine tumor G2 (NET G2), 69 patients had neuroendocrine carcinoma G3 (NEC G3) and 20 patients had mixed adenoneuroendocrine carcinoma (MANEC). The median survival was not achieved for both NET G1 and NET G2 versus 19&nbsp;months (range 3&ndash;48) for NEC G3 and 10.5&nbsp;months (range 3&ndash;45) for MANEC. The 3-year survival rates for stage I, II, III, and IV were 91.1&nbsp;%, 78.6&nbsp;%, 51.1&nbsp;% and 11.8&nbsp;%, respectively (P&thinsp;&lt;&thinsp;0.001). As for the prognostic analysis, both surgical margin and the newly updated World Health Organization (WHO) classification were independent predictors of overall survival (OS).

Conclusions: G-NENs are a kind of rare tumors, and patients with NET G3 and MANEC have unfavorable prognosis even surgically treated. Moreover, surgical margin and the new 2010 WHO criteria are closely associated with OS for G-NENs.

No MeSH data available.