Surgery with Radical Intent: Is There an Indication for G3 Neuroendocrine Neoplasms?
Adult
Aged
Aged, 80 and over
Carcinoma, Neuroendocrine
/ pathology
Chemotherapy, Adjuvant
Colectomy
Colorectal Neoplasms
/ pathology
Digestive System Surgical Procedures
/ methods
Disease-Free Survival
Esophagectomy
Female
Gastrectomy
Gastrointestinal Neoplasms
/ pathology
Humans
Ki-67 Antigen
Male
Margins of Excision
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local
/ epidemiology
Neoplasm Staging
Neuroendocrine Tumors
/ pathology
Pancreatectomy
Pancreatic Neoplasms
/ pathology
Pancreaticoduodenectomy
Platinum Compounds
/ therapeutic use
Proctectomy
Retrospective Studies
Survival Rate
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
26
03
2019
pubmed:
14
11
2019
medline:
31
12
2020
entrez:
14
11
2019
Statut:
ppublish
Résumé
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. 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%.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
Surgery with radical intent might represent a valid option for GEP-NEN G3 patients with locoregional disease, especially with Ki67 value ≤ 55%.
Identifiants
pubmed: 31720931
doi: 10.1245/s10434-019-08049-5
pii: 10.1245/s10434-019-08049-5
doi:
Substances chimiques
Ki-67 Antigen
0
Platinum Compounds
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM