Background
Patients with gastroenteropancreatic neuroendocrine tumors often present with stage
IV disease. Primary tumor resection in these patients remains controversial. Herein,
we studied the impact of primary tumor removal, identified variables associated with
prolonged survival for each neuroendocrine tumor subtype, and determined factors that
influence surgeons to perform primary tumor resection.
Methods
Patients with metastatic gastroenteropancreatic neuroendocrine tumors diagnosed from
2004 to 2014 were identified from the National Cancer Database. Nested Cox proportional
hazards and logistic regression models were used to assess variables associated with
survival and primary resection.
Results
A total of 14,510 patients met inclusion criteria. On multivariable analysis, resection
of the primary tumor and grade 1 or 2 tumors was associated with prolonged survival
in all subtypes (P < .001). Organ-specific variables associated with prolonged survival in patients
undergoing primary tumor resection included the following: low grade for all organs;
young age for pancreatic, small intestinal, colonic, and rectal neuroendocrine tumor;
tumor size for colonic and rectal neuroendocrine tumor; and tumor location for colonic
neuroendocrine tumor. Low tumor grade was found to be significantly associated with
removal of the primary tumor across all organs.
Conclusion
This study is the first suggesting that primary tumor resection is associated with
prolonged survival for all gastro-entero-pancreatic NETs. Additional variables related
to survival for each NET subtype were identified and might help select patients who
benefit from primary tumor removal.
Keywords
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Article info
Publication history
Published online: October 23, 2018
Accepted:
September 5,
2018
Received in revised form:
August 11,
2018
Received:
June 14,
2018
Footnotes
Presented at the 2017 American College of Surgeons Clinical Congress
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
