The impact of surgical resection on prognosis in gastric neuroendocrine tumors

Abstract

Aims: This study aimed to investigate the pathological factors influencing prognosis in patients undergoing surgical resection for GNETs, in the context of the World Health Organization 2010 staging system. Methods: This retrospective study included 27 patients who underwent surgical resection for GNETs diagnosis between 2001 and 2015. Patients were clinically categorized into four types based on gastric NET characteristics: type 1 tumors, which are typified by hypergastrinemia and develop on a background of atrophic gastritis; type 2 tumors, which are related with gastrinomas; type 3 tumors, which have low serum gastrin levels and no underlying mucosal pathology, and type 4, which are characterized by neuroendocrine carcinoma. Additionally, all patients were classified according to the TNM staging system. Results: The median age of the patients was 56 years (range: 33-81), and most patients were identified as type I (55.6%), with subsequent groups being type IV (25.9%) and type III (18.5%). The majority of type I patients were classified as stage I, while the majority of type III patients were in stage IIA, and most type IV patients were in stage IIIB. Type III and type IV groups exhibited a higher rate of lymph node metastasis compared to type I group (Type I: 13.3% vs. Type II: 80.0% vs. Type IV: 57.1%, p < 0.001). The mortality rate was higher in the Type IV group compared to other groups (Type I: 0% vs. Type II: 20% vs. Type IV: 57.1%, p < 0.001). The Ki-67 levels were higher in patients with lymph node metastasis than in those without. Conclusion: Type III and IV GNETs are at a higher risk of lymph node metastasis and mortality. The Ki-67 value assessed through preoperative endoscopic biopsy may serve as a guide for deciding on the necessity of lymph node dissection.