Surgery with Radical Intent: Is There an Indication for G3 Neuroendocrine Neoplasms?
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 chemother...
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| Published in: | Annals of surgical oncology Vol. 27; no. 5; pp. 1348 - 1355 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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Cham
Springer International Publishing
01.05.2020
Springer Nature B.V |
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| ISSN: | 1068-9265, 1534-4681, 1534-4681 |
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| Abstract | 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%. |
|---|---|
| AbstractList | 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.BACKGROUNDWhile 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.PATIENTS AND METHODSMulticenter 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.RESULTSSixty 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%.CONCLUSIONSSurgery with radical intent might represent a valid option for GEP-NEN G3 patients with locoregional disease, especially with Ki67 value ≤ 55%. 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%. BackgroundWhile 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 MethodsMulticenter analysis of a series of stage I–III GEP-NEN G3 patients receiving radical surgery (R0/R1) with/without adjuvant chemotherapy was performed.ResultsSixty 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.ConclusionsSurgery 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. 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%. |
| Author | Arsenic, Ruza Lipp, Rainer W. Agaimy, Abbas Kump, Patrizia Falconi, Massimo Andreasi, Valentina Gress, Thomas M. Pavel, Marianne E. Christ, Emanuel Wiedenmann, Bertram Merola, Elettra Partelli, Stefano Cremer, Birgit Kollár, Attila Rinke, Anja Pascher, Andreas Jann, Henning Perren, Aurel Kaemmerer, Daniel Panzuto, Francesco |
| Author_xml | – sequence: 1 givenname: Elettra surname: Merola fullname: Merola, Elettra email: elettra.merola@gmail.com organization: Department of Gastroenterology, Azienda Provinciale per i Servizi Sanitari (APSS), Department of Medicine 1, Division of Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Digestive and Liver Diseases Unit, Sant’Andrea Hospital – sequence: 2 givenname: Anja surname: Rinke fullname: Rinke, Anja organization: Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital Marburg and Philipps University Marburg – sequence: 3 givenname: Stefano surname: Partelli fullname: Partelli, Stefano organization: Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital IRCCS – sequence: 4 givenname: Thomas M. surname: Gress fullname: Gress, Thomas M. organization: Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital Marburg and Philipps University Marburg – sequence: 5 givenname: Valentina surname: Andreasi fullname: Andreasi, Valentina organization: Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital IRCCS – sequence: 6 givenname: Attila surname: Kollár fullname: Kollár, Attila organization: Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern – sequence: 7 givenname: Aurel surname: Perren fullname: Perren, Aurel organization: Institute of Pathology, University of Bern – sequence: 8 givenname: Emanuel surname: Christ fullname: Christ, Emanuel organization: Department of Endocrinology, Diabetology and Metabolism, Center of Endocrine and Neuroendocrine Tumors, University Hospital of Basel – sequence: 9 givenname: Francesco surname: Panzuto fullname: Panzuto, Francesco organization: Digestive and Liver Diseases Unit, Sant’Andrea Hospital – sequence: 10 givenname: Andreas surname: Pascher fullname: Pascher, Andreas organization: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Department of Surgery, Charité Universitätsmedizin – sequence: 11 givenname: Henning surname: Jann fullname: Jann, Henning organization: Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Mitte, Charité Universitätsmedizin – sequence: 12 givenname: Ruza surname: Arsenic fullname: Arsenic, Ruza organization: Department of Pathology, Campus Mitte, Charité Universitätsmedizin – sequence: 13 givenname: Birgit surname: Cremer fullname: Cremer, Birgit organization: Department of Internal Medicine I, Center for Integrated Oncology Cologne/Bonn, University Hospital of Cologne – sequence: 14 givenname: Daniel surname: Kaemmerer fullname: Kaemmerer, Daniel organization: Department of General and Visceral Surgery, Zentralklinik Bad Berka – sequence: 15 givenname: Patrizia surname: Kump fullname: Kump, Patrizia organization: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University – sequence: 16 givenname: Rainer W. surname: Lipp fullname: Lipp, Rainer W. organization: Division of Oncology, Department of Internal Medicine, Medical University – sequence: 17 givenname: Abbas surname: Agaimy fullname: Agaimy, Abbas organization: Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital – sequence: 18 givenname: Bertram surname: Wiedenmann fullname: Wiedenmann, Bertram organization: Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Mitte, Charité Universitätsmedizin – sequence: 19 givenname: Massimo surname: Falconi fullname: Falconi, Massimo organization: Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital IRCCS – sequence: 20 givenname: Marianne E. surname: Pavel fullname: Pavel, Marianne E. organization: Department of Medicine 1, Division of Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Mitte, Charité Universitätsmedizin |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31720931$$D View this record in MEDLINE/PubMed |
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While platinum-based chemotherapy represents the standard treatment for advanced grade 3 (G3) neuroendocrine neoplasms (NENs) according to the... While platinum-based chemotherapy represents the standard treatment for advanced grade 3 (G3) neuroendocrine neoplasms (NENs) according to the European... BackgroundWhile platinum-based chemotherapy represents the standard treatment for advanced grade 3 (G3) neuroendocrine neoplasms (NENs) according to the... |
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| Title | Surgery with Radical Intent: Is There an Indication for G3 Neuroendocrine Neoplasms? |
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