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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Bibliographic Details
Published in:Annals of surgical oncology Vol. 27; no. 5; pp. 1348 - 1355
Main Authors: Merola, Elettra, Rinke, Anja, Partelli, Stefano, Gress, Thomas M., Andreasi, Valentina, Kollár, Attila, Perren, Aurel, Christ, Emanuel, Panzuto, Francesco, Pascher, Andreas, Jann, Henning, Arsenic, Ruza, Cremer, Birgit, Kaemmerer, Daniel, Kump, Patrizia, Lipp, Rainer W., Agaimy, Abbas, Wiedenmann, Bertram, Falconi, Massimo, Pavel, Marianne E.
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01.05.2020
Springer Nature B.V
Subjects:
Adult
Aged
Aged, 80 and over
Carcinoma, Neuroendocrine - pathology
Carcinoma, Neuroendocrine - surgery
Chemotherapy
Chemotherapy, Adjuvant
Colectomy
Colorectal Neoplasms - pathology
Colorectal Neoplasms - surgery
Digestive System Surgical Procedures - methods
Disease-Free Survival
Endocrine Tumors
Esophagectomy
Female
Gastrectomy
Gastrointestinal Neoplasms - pathology
Gastrointestinal Neoplasms - surgery
Humans
Ki-67 Antigen
Male
Margins of Excision
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local - epidemiology
Neoplasm Staging
Neuroendocrine tumors
Neuroendocrine Tumors - pathology
Neuroendocrine Tumors - surgery
Oncology
Pancreatectomy
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy
Patients
Platinum
Platinum Compounds - therapeutic use
Proctectomy
Retrospective Studies
Risk factors
Statistical analysis
Surgery
Surgical Oncology
Survival
Survival Rate
ISSN:1068-9265, 1534-4681, 1534-4681
Online Access:Get full text
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Summary: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%.
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ISSN:1068-9265
1534-4681
1534-4681
DOI:10.1245/s10434-019-08049-5