NANETS2022 15th Annual Multidisciplinary NET Medical Symposium NANETS 2022 Clinical – Surgery/Applied Pathology (13 abstracts)
Is There a Role for Surgical Resection of Grade 3 Neuroendocrine Neoplasms?
Luis C. Borbon, MD1, Catherine G. Tran, MD1, Scott K. Sherman, MD1, Po Hien Ear, PhD1, Chandrikha Chandrasekharan, MD2, Andrew M. Bellizzi, MD3, Joseph S. Dillon, MD2, Thomas M. O’Dorisio, MD2 & James R. Howe, MD1
1Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA; 2Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; 3Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA.
Background: Grade 3 (G3) gastroenteropancreatic (GEP) neuroendocrine neoplasms (NENs) are aggressive tumors with poor survival outcomes for which medical management is usually 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), including 276 from small bowel, 157 from pancreas, and 30 from stomach/duodenum/right colon. 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. On multivariable cox-analysis grade and TNM-stage correlated with survival, with better survival in resected than non-resected G3NETs (Table).
| WHO Classification (n) | Median OS (months) | HR (95% CI) | P-value* | ||||||
| G1NET (n=211) | 268.1 | Reference | - | ||||||
| G2NET (n=208) | 129.9 | 1.89 (1.27 to 2.81) | 0.002 | ||||||
| G3NET (n=39) | 50.5 | 4.70 (2.42 to 9.11) | <0.001 | ||||||
| G3NEC (n=5) | 28.5 | 7.99 (2.42 to 26.4) | <0.001 | ||||||
| G3NET- No resection (n=12) | 19.0 | 15.2 (6.93 to 33.5) | <0.001 | ||||||
| G3NEC- No resection (n=19) | 12.4 | 21.8 (12.0 to 39.4) | <0.001 | ||||||
| WHO = World Health Organization; OS = Overall Survival; HR = Hazard Ratio; CI = Confidence Interval;* Using multivariable cox proportional hazards model adjusting for grade and T, N, M-stage | |||||||||
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 G3NETs.
Abstract ID 21440
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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