Abstract
Background
Attributable to the high likelihood of developing distant metastatic disease, resection
of poorly differentiated gastroenteropancreatic neuroendocrine neoplasms is generally
contraindicated. Some patients with no distant metastatic disease will nonetheless
undergo surgical resection and their outcomes are not known. We aimed to determine
whether surgery confers survival advantage over systemic therapy alone for patients
with non-metastatic poorly differentiated gastroenteropancreatic neuroendocrine neoplasms.
Methods
We performed a retrospective cohort study (2000–2012) of adults in the California
Cancer Registry who had poorly differentiated gastroenteropancreatic neuroendocrine
neoplasms (World Health Organization Grade 3) and no clinical evidence of distant
metastasis (M0). Patients who underwent surgery were compared with those managed non-operatively.
The adjusted Cox proportional hazards model was used to assess the risk of death.
Results
Among 2,245 patients (45% female, 21% pancreatic, 79% gastrointestinal), 1,549 (69%)
were treated with surgery, and 696 (31%) received either systemic therapy or palliative
measures alone. Median survival was 31 months after surgery versus 9 months after
non-operative therapy (log-rank test, P < .001). Rates of 5-year overall survival were 39% after surgery versus 10% in the
non-operative group. Adjusting for age, sex, comorbidities, receipt of chemotherapy,
and tumor size and location, patients treated with surgery had a 58% lower likelihood
of death compared with non-operative therapy (hazard ratio: 0.42, 95% confidence interval:
0.36–0.50, P < .001). Restricting our results to those patients who were found to have no distant
metastasis intraoperatively (ie, pathologically M0), 5-year survival after surgery
reached 44%.
Conclusion
While poorly differentiated gastroenteropancreatic neuroendocrine neoplasms carries
a poor prognosis, for patients with no evidence of metastatic disease, resection appears
to confer significant improvement in long-term survival. Although caution and an individualized
approach in treating poorly differentiated gastroenteropancreatic neuroendocrine neoplasms
is advised, future guidelines might reflect this survival advantage.
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Article info
Publication history
Published online: February 23, 2021
Accepted:
January 18,
2021
Footnotes
Lucas Thornblade and Gagandeep Singh were responsible for study design and data analysis. Philip Ituarte was responsible for data acquisition. Lucas Thornblade was responsible for drafting the manuscript. All authors were responsible for manuscript revision. Gagandeep Singh led the team.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Re: “Does surgery provide a survival advantage in nondisseminated poorly differentiated gastroenteropancreatic neuroendocrine neoplasms”SurgeryVol. 171Issue 5
- PreviewWe read with great interest the article titled “Does Surgery Provide a Survival Advantage in Nondisseminated Poorly Differentiated Gastroenteropancreatic Neuroendocrine Neoplasms?” by Thornblade et al, published in Surgery.1 Thornblade et al stressed surgery as a cornerstone of treatment in nonmetastatic poorly differentiated neuroendocrine neoplasms, as surgical resection increases long-term survival. Surprisingly, the authors considered all neuroendocrine neoplasms, regardless of their location, as a unique group.
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