Survival outcomes and surgical intervention of small intestinal neuroendocrine tumors: a population based retrospective study.

Lunpo Wu,Sanchuan Lai,Daniel C Chung,Liangjing Wang,Jing Zhong,Li Wan,Jianfei Fu,Jie Pan

doi:10.18632/oncotarget.13632

Abstract

BackgroundSmall intestinal neuroendocrine tumors (SiNETs) without distant metastasis typically behave in an indolent manner, but there can be heterogeneity. We aimed to define the survival outcomes and impacts of surgical intervention.MethodsA retrospective cohort study was conducted by using data from the Surveillance, Epidemiology, and End Results (SEER) database. Clinicopathologic features were analyzed in 4407 patients between 2000 and 2012. The cancer specific survival (CSS) was calculated by the Kaplan-Meier method. Multivariable Cox regression models with hazard ratios (HRs) were constructed to analyze survival outcomes and risk factors.ResultsThe adjusted incidence of early SiNETs is 1.3/100,000. Tumors are most commonly located in the ileum and are small (≤ 2 cm). The 5-year and 10-year CSS rates were 95.0% and 88.5%, respectively. Age > 50 years, large tumor size (> 2cm), poor differentiation, advanced T classification, and absence of surgical treatment were independent predictors of poor survival. Stratified analysis indicated that surgery significantly improved survival in patients that were white (HR, 0.45), > 50 years old (HR, 0.61), had duodenal tumors (HR, 0.43), large tumors (> 2cm) (HR, 0.32), advanced T classification (T3: HR, 0.29; T4: HR, 0.18) or well differentiation (HR, 0.55). There was no significant survival difference between local resection and radical resection (P =0.884).ConclusionsEarly SiNETs have a favorable prognosis. Surgical resection may improve outcomes, particularly in older patients and those with large tumors. More aggressive resections couldn't improve outcomes.

Highlights

Neuroendocrine tumors (NETs) are heterogeneous, slow-growing tumors that derive from diffuse neuroendocrine cells throughout the body [1]
Stratified analysis indicated that surgery significantly improved survival in patients that were white (HR, 0.45), > 50 years old (HR, 0.61), had duodenal tumors (HR, 0.43), large tumors (> 2cm) (HR, 0.32), advanced T classification (T3: Hazard ratio (HR), 0.29; T4: HR, 0.18) or well differentiation (HR, 0.55)
Tumors more commonly originated in the ileum (39.9%) and duodenum (32.2%), followed by jejunum (5.2%) and Not otherwise specified (NOS) (22.7%). 50.8% were diagnosed as T1 or T2 tumors and 49.8% were classified as N0. 57.9% of tumors were small in size and 89% of early Small intestinal neuroendocrine tumors (SiNETs) were welldifferentiated

Summary

Introduction

Neuroendocrine tumors (NETs) are heterogeneous, slow-growing tumors that derive from diffuse neuroendocrine cells throughout the body [1]. Oberndorfer et al first described these tumors in the small intestine and coined the term Karzinoid (carcinoid) in 1907 [2]. He initially considered carcinoid tumors as benign and “carcinoma-like” before their malignancy was further recognized[3]. In 2010, the World Health Organization (WHO) classification replaced “carcinoid” with the terms neuroendocrine tumors and neuroendocrine carcinomas[4]. Small intestinal neuroendocrine tumors (SiNETs) without distant metastasis typically behave in an indolent manner, but there can be heterogeneity. We aimed to define the survival outcomes and impacts of surgical intervention

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Conclusion