Journal article
Surgery with Radical Intent: Is There an Indication for G3 Neuroendocrine Neoplasms?
- Merola E Department of Gastroenterology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy. elettra.merola@gmail.com.
- Rinke A Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany.
- Partelli S Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital IRCCS, Milan, Italy.
- Gress TM Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany.
- Andreasi V Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital IRCCS, Milan, Italy.
- Kollár A Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Perren A Institute of Pathology, University of Bern, Bern, Switzerland.
- Christ E Department of Endocrinology, Diabetology and Metabolism, Center of Endocrine and Neuroendocrine Tumors, University Hospital of Basel, Basel, Switzerland.
- Panzuto F Digestive and Liver Diseases Unit, Sant'Andrea Hospital, Rome, Italy.
- Pascher A Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Germany.
- Jann H Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Mitte, Charité Universitätsmedizin, Berlin, Germany.
- Arsenic R Department of Pathology, Campus Mitte, Charité Universitätsmedizin, Berlin, Germany.
- Cremer B Department of Internal Medicine I, Center for Integrated Oncology Cologne/Bonn, University Hospital of Cologne, Cologne, Germany.
- Kaemmerer D Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.
- Kump P Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University, Graz, Austria.
- Lipp RW Division of Oncology, Department of Internal Medicine, Medical University, Graz, Austria.
- Agaimy A Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital, Erlangen, Germany.
- Wiedenmann B Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Mitte, Charité Universitätsmedizin, Berlin, Germany.
- Falconi M Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital IRCCS, Milan, Italy.
- Pavel ME Department of Medicine 1, Division of Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
- 2019-11-14
Published in:
- Annals of surgical oncology. - 2020
English
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%.
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%.
- Language
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- English
- Open access status
- closed
- Identifiers
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- DOI 10.1245/s10434-019-08049-5
- PMID 31720931
- Persistent URL
- https://sonar.ch/global/documents/167194
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