Is There a Role for Surgical Resection of Grade 3 Neuroendocrine Neoplasms?

Luis C. Borbon; Catherine G. Tran; Scott K. Sherman; Po Hien Ear; Chandrikha Chandrasekharan; Andrew M. Bellizzi; Joseph S. Dillon; Thomas M. O’Dorisio; James R. Howe

doi:10.1245/s10434-022-12100-3

Back

Is There a Role for Surgical Resection of Grade 3 Neuroendocrine Neoplasms?

Journal article

Open access

Peer reviewed

Is There a Role for Surgical Resection of Grade 3 Neuroendocrine Neoplasms?

Luis C. Borbon, Catherine G. Tran, Scott K. Sherman, Po Hien Ear, Chandrikha Chandrasekharan, Andrew M. Bellizzi, Joseph S. Dillon, Thomas M. O’Dorisio and James R. Howe

Annals of surgical oncology, Vol.29(11), pp.6936-6946

07/08/2022

DOI: 10.1245/s10434-022-12100-3

PMCID: PMC10399278

PMID: 35802214

Files and links (1)

url

https://pmc.ncbi.nlm.nih.gov/articles/PMC10399278/pdf/nihms-1918701.pdfView

Open Access

Abstract

Background Grade 3 (G3) gastroenteropancreatic (GEP) neuroendocrine neoplasms (NENs) are aggressive tumors with poor survival outcomes for which medical management is generally recommended. This study sought to evaluate outcomes of surgically treated G3 GEP-NEN patients. Methods A single-institutional prospective NEN database was reviewed. Patients with G3 GEP-NENs based on World Health Organization (WHO) 2019 definitions included well-differentiated neuroendocrine tumors (G3NET) and poorly differentiated neuroendocrine carcinomas (G3NEC). Clinicopathologic factors were compared between groups. Overall survival from G3 diagnosis was assessed by the Kaplan-Meier method. Results Surgical resection was performed for 463 patients (211 G1, 208 G2, 44 G3). Most had metastatic disease at presentation (54% G1, 69% G2, 91% G3; p < 0.001). The G3 cohort included 39 G3NETs and 5 G3NECs, 22 of pancreatic and 22 of midgut origin. Median overall survival (mOS; in months) was 268.1 for G1NETs, 129.9 for G2NETs, 50.5 for G3NETs, and 28.5 for G3NECs ( p < 0.001). Over the same period, 31 G3 patients (12 G3NETs, 19 G3NECs) were treated non-surgically, with mOS of 19.0 for G3NETs and 12.4 for G3NECs. Conclusions Surgical resection of G3 GEP-NENs remains controversial due to poor prognosis, and surgical series are rare. This large, single-institutional study found significantly lower mOS in patients with resected G3NENs than those with G1/G2 tumors, reflecting more aggressive tumor biology and a higher proportion with metastatic disease. The mOS for resected G3NETs and G3NECs exceeded historical non-surgical G3NEN series (mOS 11–19 months), suggesting surgery should be considered in carefully selected patients with G3NENs, especially those with well-differentiated tumors.

Oncology

Surgery

Surgical Oncology

Endocrine Tumors

Medicine

Medicine & Public Health

Details

Title: Subtitle: Is There a Role for Surgical Resection of Grade 3 Neuroendocrine Neoplasms?
Creators: Luis C. Borbon - Roy J. and Lucille A. Carver College of Medicine
Catherine G. Tran - University of Iowa
Scott K. Sherman - University of Iowa
Po Hien Ear - University of Iowa
Chandrikha Chandrasekharan - University of Iowa
Andrew M. Bellizzi - University of Iowa
Joseph S. Dillon - University of Iowa
Thomas M. O’Dorisio - University of Iowa
James R. Howe - Roy J. and Lucille A. Carver College of Medicine
Resource Type: Journal article
Publication Details: Annals of surgical oncology, Vol.29(11), pp.6936-6946
DOI: 10.1245/s10434-022-12100-3
PMID: 35802214
PMCID: PMC10399278
NLM abbreviation: Ann Surg Oncol
ISSN: 1068-9265
eISSN: 1534-4681
Publisher: Springer International Publishing
Grant note: CA078586 / Radiation Biology T32 Training Grant CA148062-01 / Iowa T32 Surgical Oncology Training Grant P50 CA174521-01 / Iowa Neuroendocrine SPORE Grant
Language: English
Date published: 07/08/2022
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Pathology; Surgery; Fraternal Order of Eagles Diabetes Research Center; Endocrinology and Metabolism; Internal Medicine
Record Identifier: 9984296302002771

Metrics

17 Record Views

14 Times Cited - Web of Science