Management of gastric neuro-endocrine tumours in a large French national cohort (GTE)

Abstract

Gastric neuro-endocrine tumours (GNETs) Eighty four tumours were type 1 (46.4%); 5 types 2 (2.8%); 52 types 3 (28.7%) and 40 types 4 (22.1%). Types 1 and 2 were first endoscopically managed in respectively 93% and 60% of cases, whereas surgery was first done respectively in 45% and 42% of types 3 and 4. Systemic treatment, chemotherapy and/or somatostatin analogue (SSA), was first administered exclusively for types 3 and 4. Near 3% of types 1 and 40% of types 2 received at a time SSA treatment. Five-year survival rates were 98.3%, 100%, 63.2% and 31.8% for types 1, 2, 3 and 4 respectively. Conclusion: The great majority of GNETs registered in this national cohort are treated in accordance with the current guidelines. The survival rates we reported must be interpreted with caution, because this cohort registered preferentially selected patients eligible for treatment. The registration of all the GNETs, in particular type 1 considered as benign and type 4 not eligible for specific anti-cancer treatment must be encouraged.3

Gastric neuroendocrine tumor: A practical literature review

“…This results in hypergastrinemia as a physiological response to the demand generated by the shortage of HCl. The excess of gastrin generates hypertrophy and hyperplasia of the ECFs, favoring the appearance of innumerable small lesions, which are usually not very aggressive[ 18 , 20 , 22 , 23 ]. Serum gastrin is always elevated in type I G-NETs.…”

“…Serum gastrin is always elevated in type I G-NETs. Vitamin B12 deficiency with or without macrocytic anemia (pernicious or megaloblastic) may be present due to the reduction of the intrinsic factor, with a consequent reduction in the absorption of vitamin B12[ 18 , 20 , 22 - 24 ]. Parallel to this, serum antiparietal cell antibodies are positive in 80% of cases[ 20 , 24 - 26 ].…”

“…The diagnosis is made by upper digestive endoscopy with biopsy. There are pale, yellowish and transparent blood vessels that contrast with the smooth and red mucosa of areas not affected by the tumor, presenting as red, small and numerous polyps[ 11 , 19 , 20 , 22 , 24 - 26 ]. Histological analysis of the gastric mucosa shows atrophy of mucosal cells, hyperplasia of neuroendocrine cells and absence of parietal cells.…”

“…However, for lesions ≥ 1 cm, echo-endoscopy is recommended to identify the depth of tumor invasion in the gastric wall and the possible involvement of regional lymph nodes. Gastrectomy is reserved for submucosa tumors and/or lymph node involvement and/or positive margin in the polypectomy sample[ 19 , 22 , 28 ]. Patients with small type I G-NETs are managed by regular endoscopic follow-up.…”

“…Reports of the use of somatostatin analogues in small groups of patients showed that the interruption after 12 mo caused the serum gastrin to rise again without the reappearance of new lesions[ 11 , 31 , 32 ]. However, data are still insufficient to show the long-term efficacy of pharmacological treatment of localized type I G-NETs[ 21 , 22 ]. More rarely, antrectomy may be indicated in an attempt to reduce hypergastrinemia.…”