The overriding role of surgery and tumor grade for long-term survival in patients with gastroenteropancreatic neuroendocrine neoplasms: A population-based cohort study.

Jon Arne Søreide,Kjetil Søreide,Oddvar M. Sandvik,Einar Gudlaugsson,Torjan M. Haslerud,Mohammed Al‐Saiddi,Dordi Lea,Jan Terje Kvaløy,Herish Garresori,Lars N. Karlsen

doi:10.1002/cnr2.1462

Abstract

BackgroundGastroenteropancreatic neuroendocrine neoplasms (GEP‐NENs) comprise a heterogeneous disease group. Factors that affect long‐term survival remain uncertain. Complete population‐representative cohorts with long‐term follow‐up are scarce.AimTo evaluate factors of importance for the long‐term survival.Methods and resultsAn Observational population‐based study on consecutive GEP‐NEN patients diagnosed from 2003 to 2013, managed according to national guidelines. Univariable and multivariable survival analyses were performed to evaluate overall survival (OS) and to identify independent prognostic factors. One hundred ninety eligible patients (males, 58.9%) (median age, 60.0 years; range, 10.0–94.2 years) were included. The small bowel, appendix, and pancreas were the most common tumor locations. The World Health Organization (WHO) tumor grade 1–3 distributions varied according to the primary location and disease stage. Primary surgery with curative intent was performed in 66% of the patients. The median OS of the study population was 183 months with 5‐ and 10‐year OS rates of 66% and 57%, respectively. Only age, WHO tumor grade, and primary surgical treatment were independent prognostic factors for OS.ConclusionThe outcomes of GEP‐NEN patients are related to several factors including age and primary surgical treatment. WHO tumor grading, based on the established criteria, should be routine in clinical practice. This may improve clinical decision‐making and allow the comparison of outcomes among different centers.

Highlights

This study aimed to evaluate the long-term survival in a population-based cohort of consecutive GEP-NEN patients treated in routine practice who were classified according to current grading and staging criteria of the given time period.[12,13]
While males showed a slight predominance of 58.9%, no significant differences were observed between sexes in the distribution of the primary tumor location
In patients whose primary tumors were in the appendix, the median age of 30.4 years was significantly lower than the median age of 62.5 years in patients whose primary tumors were in other locations (p < .001)

Summary

Introduction

Many patients with well-differentiated neuroendocrine neoplasms, even those with advanced disease at the time of diagnosis, can survive for several years.[5,8,9,10] In terms of the prevalence in this group of patients, GEP-NENs are the most common gastrointestinal malignancy after colorectal cancer.[1] This translates into a considerable number of patients requiring long-term surveillance and treatment. WHO tumor grade, and primary surgical treatment were independent prognostic factors for OS. Conclusion: The outcomes of GEP-NEN patients are related to several factors including age and primary surgical treatment. WHO tumor grading, based on the established criteria, should be routine in clinical practice This may improve clinical decision-making and allow the comparison of outcomes among different centers

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Conclusion