Journal article
Surgical Management of G3 Gastroenteropancreatic Neuroendocrine Neoplasms: A Systematic Review and Meta-analysis
Annals of surgical oncology, Vol.30(1), pp.148-160
01/2023
DOI: 10.1245/s10434-022-12643-5
PMID: 36227392
Abstract
BACKGROUNDGrade 3 (G3) gastroenteropancreatic (GEP) neuroendocrine neoplasms (NENs) are rare, aggressive tumors with poor prognosis. The World Health Organization 2017 and 2019 classifications further subdivided G3 NENs into G3 neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs). Current guidelines favor medical management in most of these patients, and the role of surgical management is not well defined. We performed a systematic literature review and meta-analysis of surgical management versus nonsurgical management for G3 GEP NENs. MATERIALS AND METHODSA PRISMA-compliant systematic review of the MEDLINE, Embase, Scopus, and Cochrane Library databases (end-of-search date: 16 July 2021) was conducted. Individual patient survival data were reconstructed, and random-effects meta-analyses were performed. RESULTSFourteen studies comprising 1810 surgical and 910 nonsurgical patients were systematically reviewed. Publication bias adjusted meta-analysis of 12 studies (1788 surgical and 857 nonsurgical patients) showed increased overall survival (OS) after surgical compared with nonsurgical management for G3 GEP NENs [hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.31-0.53]. Subgroup meta-analyses showed increased OS after surgical management for both pancreatic and gastrointestinal primary sites separately. In another subgroup meta-analysis of G3 GEP NETs (not NECs), surgical management was associated with increased OS compared with nonsurgical management (HR 0.26, 95% CI 0.11-0.61). CONCLUSIONSSurgical management of G3 GEP NENs may provide a potential survival benefit in well-selected cases. Further research is needed to define which patients will benefit most from surgical versus nonsurgical management. The current literature is limited by inconsistent reporting of survival outcomes in surgical versus nonsurgical groups, tumor grade, differentiation, primary tumor site, and selection criteria for surgical and nonsurgical management.
Details
- Title: Subtitle
- Surgical Management of G3 Gastroenteropancreatic Neuroendocrine Neoplasms: A Systematic Review and Meta-analysis
- Creators
- Ioannis A Ziogas - University of Colorado Anschutz Medical CampusPanagiotis T TasoudisLuis C BorbonScott K ShermanPatrick J BrehenyChandrikha ChandrasekharanJoseph S DillonAndrew M BellizziJames R Howe
- Resource Type
- Journal article
- Publication Details
- Annals of surgical oncology, Vol.30(1), pp.148-160
- DOI
- 10.1245/s10434-022-12643-5
- PMID
- 36227392
- ISSN
- 1068-9265
- eISSN
- 1534-4681
- Grant note
- name: Iowa SPORE for Neuroendocrine Tumors, award: P50 CA174521-01
- Language
- English
- Electronic publication date
- 10/13/2022
- Date published
- 01/2023
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Pathology; Biostatistics; Surgery; Fraternal Order of Eagles Diabetes Research Center; Endocrinology and Metabolism; Internal Medicine
- Record Identifier
- 9984306233602771
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