Gastric Neuroendocrine Carcinoma with Rapid Progression

Iwamoto, Maho; Gotoda, Takuji; Noda, Yoichi; Esaki, Mitsuru; Moriyama, Mitsuhiko; Yoshida, Nao; Takayama, Tadatoshi; Kobayashi, Hiroko; Masuda, Shinobu

doi:10.2169/internalmedicine.3961-19

Cited by 7 publications

(8 citation statements)

References 19 publications

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Section: Introductionmentioning

confidence: 99%

“…3 By comparison, gastric neuroendocrine carcinoma (GNEC) is a rare disease, which occupies 0.1% to 0.6% of the whole GC. 4 In definition, GNEC constitutes the proliferation of poorly differentiated endocrine cells with distinct cellular atypia, possibly originated from dedifferentiation of adenocarcinoma cells to the endocrine cells. 5 Based on the morphology and proliferation rate, current neuroendocrine neoplasms are classified as well differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinoma (NEC).…”

Section: Introductionmentioning

confidence: 99%

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The Clinicopathological Features and Overall Survival of Patients With Gastric Neuroendocrine Carcinoma

Chu

et al. 2021

Technol Cancer Res Treat

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Objectives: Gastric neuroendocrine carcinoma (GNEC) is a class of rare histological subtypes in gastric cancer (GC). This retrospective case-control study aimed to explore the clinicopathological features and overall survival (OS) of patients with GNEC. Methods: A large population of GNEC and intestinal-type GC (IGC) patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The 1:1 propensity score matching (PSM) analysis was initiated to adjust the confounders between GNEC and IGC cohorts. Kaplan-Meier (KM) plots with log-rank tests were used to compare the survival differences in GNEC versus IGC. Additionally, Cox proportional hazard regression models were adopted to characterize the prognostic factors relevant to OS of the GNEC patients. Results: An entity of 4596 patients were collected, including 3943 (85.8%) IGC patients and 653 (14.2%) GNEC patients. The PSM analysis well-balanced all confounders in GNEC versus IGC (all P > .05). The KM plots showed that GNEC had significantly superior OS to IGC both before and after PSM analysis. Before PSM, the median OS was 52 (33.6-70.4) months in GNEC versus 32 (29.3-34.7) months in IGC ( P = .0015). After PSM, the median OS was 26 (18.3-33.7) months in GNEC versus 21 (17.7-24.3) months in IGC ( P = .0039). Stratified analysis indicated that GNEC had superior survivals to IGC in early stage patients and those who received surgery. In Cox regression analysis, age ≥ 60, tumor size > 50 mm, stage II-IV, T2, and N3 were independent risk factors for the GNEC patients (hazard ratio [HR]>1, P < .05). By contrast, year 2010 to 2015, female, and surgery were independent protective factors for these patients (HR < 1, P < .05). Conclusions: GNEC has unique clinicopathological features quite different from IGC and may have a superior survival to IGC in early stage patients. The prognostic factors identified here may assist the clinicians to more individually treat these patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Clinicopathological Features and Overall Survival of Patients With Gastric Neuroendocrine Carcinoma

Chu

et al. 2021

Technol Cancer Res Treat

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“…Gastric cancer (GC) is a highly heterogeneous malignancy, including various pathologies which present significantly different molecular patterns, tumor behavior, and prognoses [ 1 ]. Gastric neuroendocrine carcinoma (GNEC) is a rare histology type of GC, which occupies 0.1 to 0.6% of whole patients, with an increasing trend over the past few decades [ 2 ]. GNEC is a poorly differentiated, high-grade malignancy, which presents dismal prognoses and is prone to distant metastasis [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

De-escalating chemotherapy for stage I–II gastric neuroendocrine carcinoma? A real-world competing risk analysis

Xie

et al. 2023

World J Surg Onc

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Background The role of adjuvant chemotherapy in gastric neuroendocrine neoplasms (GNEC) has not been well clarified yet. The study was designed to investigate the potential effect of adjuvant chemotherapy in stage I–II GNEC patients and construct a predictive nomogram. Method Stage I–II GNEC patients were included in the Surveillance, Epidemiology, and End Results (SEER) database and divided into chemotherapy and no-chemotherapy groups. We used Kaplan–Meier survival analyses, propensity score matching (PSM), and competing risk analyses. The predictive nomogram was then built and validated. Results Four hundred four patients with stage I–II GNEC were enrolled from the SEER database while 28 patients from Hangzhou TCM Hospital were identified as the external validation cohort. After PSM, similar 5-year cancer-specific survival was observed in two groups. The outcomes of competing risk analysis indicated a similar 5-year cumulative incidence of cancer-specific death (CSD) between the two cohorts (35.4% vs. 31.4%, p = 0.731). And there was no significant relation between chemotherapy and CSD in the multivariate competing risks regression analysis (HR, 0.79; 95% CI, 0.48–1.31; p = 0.36). Furthermore, based on the variables from the multivariate analysis, a competing event nomogram was created to assess the 1-, 3-, and 5-year risks of CSD. The 1-, 3-, and 5-year area under the receiver operating characteristic curve (AUC) values were 0.770, 0.759, and 0.671 in the training cohort, 0.809, 0.782, and 0.735 in the internal validation cohort, 0.786, 0.856, and 0.770 in the external validation cohort. Furthermore, calibration curves revealed that the expected and actual probabilities of CSD were relatively consistent. Conclusion Stage I–II GNEC patients could not benefit from adjuvant chemotherapy after surgery. De-escalation of chemotherapy should be considered for stage I–II GNEC patients. The proposed nomogram exhibited excellent prediction ability.

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“…Gastric neuroendocrine carcinoma (GNEC) is a rare malignant disease but with an increasing incidence in the past decades ( 1 ), constituting a spectrum of aggressive gastric malignancies ( 2 ). About a half of patients with GNEC were found to have distant metastasis at the time of diagnosis, with a relatively poor prognosis ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Resection of the Primary Tumor Improves the Survival of Patients With Stage IV Gastric Neuroendocrine Carcinoma

Ren

Wang

et al. 2022

Front. Oncol.

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BackgroundThe prognostic prolongation effect of surgical resection in the management of gastric neuroendocrine carcinoma (GNEC) with distant metastases was still uncertain. The purpose of this study was to investigate the association of primary tumor resection (PTR) with outcomes in patients with stage IV GNEC.MethodsThis retrospective study analyzed patients with distant metastatic GNEC diagnosed between 2000 and 2018 and identified using the Surveillance, Epidemiology, and End Results (SEER) database. Patients were divided into PTR and non-PTR groups. The stabilized inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. Overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan–Meier method and log-rank test. Cox-regression analyses (uni- and multivariate) were performed to evaluate factors potentially influencing survival.ResultsA total of 126 patients with a median follow-up of 79 months were identified. Forty-four patients underwent PTR and 82 patients did not undergo surgery. After the IPTW approach, PTR improved the OS in patients with stage IV GNEC (median OS 12 vs. 6 months, P = 0.010). The 1- and 3-year OS for patients with or without PTR were 43.8% and 34.5%, and 27.9% and 6.5%, respectively. The median CSS was 12 months for patients undergoing PTR and 6 months for those who did not. The 1 and 3-year CSS for patients with or without PTR were 45.1% and 37.0%, and 27.9% and 6.5%, respectively. In IPTW-adjusted Cox proportional hazards regression analysis, PTR was recognized as an independent factor for improved survival after the occurrence of distant metastatic disease [OS: hazard ratio (HR) = 0.305; 95% confidence interval (CI): 0.196, 0.475; and CSS: HR = 0.278; 95% CI: 0.171, 0.452].ConclusionPTR for stage IV GNEC contributes to a better prognosis compared with non-surgery. This study supported the resection of the primary tumor in patients with distant metastatic GNEC.

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Gastric Neuroendocrine Carcinoma with Rapid Progression

Cited by 7 publications

References 19 publications

The Clinicopathological Features and Overall Survival of Patients With Gastric Neuroendocrine Carcinoma

The Clinicopathological Features and Overall Survival of Patients With Gastric Neuroendocrine Carcinoma

De-escalating chemotherapy for stage I–II gastric neuroendocrine carcinoma? A real-world competing risk analysis

Resection of the Primary Tumor Improves the Survival of Patients With Stage IV Gastric Neuroendocrine Carcinoma

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