Prognostic impact of a large mesenteric mass &gt;2 cm in ileal neuroendocrine tumors

Kasai, Yosuke; Mahuron, Kelly; Hirose, Kenzo; Corvera, Carlos U.; Kim, Grace; Hope, Thomas A.; Shih, Brandon; Warren, Robert S.; Bergsland, Emily K.; Nakakura, Eric K.

doi:10.1002/jso.25727

Cited by 20 publications

(10 citation statements)

References 34 publications

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“…Only the MM contact ≥180° with SMV was independently associated with these symptoms. This finding is in line with the results of a previous study that showed that large MM (>2 cm) were as frequent among patients with a history of small bowel obstruction as smaller MM [21]. This could also be related to the small size of our study population.…”

Section: Discussion/conclusionsupporting

confidence: 93%

Small Intestinal Neuroendocrine Neoplasm: Factors Associated with the Development of Local Tumor-Related Symptoms

et al. 2021

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Introduction: Clinical presentations of small intestinal neuroendocrine neoplasms (SiNENs) can range from asymptomatic to life-threatening complications. Other than primary tumor(s), mesenteric mass (MM) can provide local tumor-related (LTR) symptoms. Although some expert centers propose routine primary resection to avoid complications in stage IV patients, some guidelines suggest avoiding primary tumor resection unless in the presence of symptoms. This study was aimed to identify factors associated with the presence or development of LTR symptoms. Methods: From 2012 to 2019, SiNEN patients with appropriate initial morphological imaging were included. All initial imaging was reviewed. Associations between factors and LTR symptoms were assessed by logistic regression. Results: Among 144 SiNEN patients, 66 met the inclusion criteria. Multivariate analysis identified on initial morphological imaging (i) any visible primary tumor (p < 0.01) and (ii) MM contact ≥180° with the superior mesenteric vessels (p ≤ 0.02), as independent factors associated with LTR symptoms in the whole study population as well as in the subgroup of primary resected patients. Among the 14 (21%) patients with both factors on initial cross-sectional conventional imaging, 12 (18%) were straightaway symptomatic at diagnosis and the remaining became symptomatic during the follow-up. All asymptomatic patients, without upfront surgery and without any predictive factor 16/18 (89%), stayed asymptomatic during the 2.7-year median follow-up. The absence of association between these 2 factors yielded a sensitivity of 100%, a specificity of 62%, and a negative predictive value of 100% for the occurrence of LTR symptoms. Conclusion: The presence of any visible primary tumor and/or MM superior mesenteric vessels contact ≥180° at initial cross-sectional imaging are 2 easily identifiable factors, which can help physicians for the decision-making regarding timing and type of surgery for SiNENs. Larger multicenter studies should endorse these results.

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Section: Discussion/conclusionsupporting

confidence: 93%

Small Intestinal Neuroendocrine Neoplasm: Factors Associated with the Development of Local Tumor-Related Symptoms

et al. 2021

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“…Reasons to opt for an open resection were related to better lymphadenectomy and tactile feedback. An adequate lymphadenectomy is of particular importance, as presence of lymph nodes have a negative impact on survival, irrespective of presence of liver metastases, and is complex in case of N2 nodes [8,13]. However, it should be noted that no differences between the number of resected lymph nodes were reported between minimally invasive and open resection by any of the comparative studies, and that R0 resection rates were higher in the minimally invasive group [3,7,9,10].…”

Section: Discussionmentioning

confidence: 91%

International survey on opinions and use of minimally invasive surgery in small bowel neuroendocrine neoplasms

Kaçmaz

Engelsman

Bemelman

et al. 2022

European Journal of Surgical Oncology

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“…Regional lymphadenopathy was associated with desmoplasia and fibrosis of the mesentery forming a mesenteric mass, which may impact on clinical and staging features in SBNETs (42)(43)(44). The updated AJCC 8th edition had incorporated mesenteric masses in staging for midgut NETs, but the prognostic validity of this classification has yet to be validated.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Performance of Different Lymph Node Staging Systems in Patients With Small Bowel Neuroendocrine Tumors

Jiang

Xie

et al. 2020

Front. Endocrinol.

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Background: The prognostic significance of the lymph node (LN) classification for small bowel neuroendocrine tumors (SBNETs) remains unknown. The aim of the present study was to evaluate and compare the prognostic assessment of different LN staging systems. Methods: Patients with SBNETs were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The X-tile program was used to determine the cutoff value of the resected lymph nodes (RLNs), negative lymph nodes (NLNs), lymph node ratio (LNR), and the log odds of positive lymph nodes (LODDS). Survival analyses were performed using Kaplan–Meier curves with log-rank test. Logistic regression analysis was used to evaluate the differences between different periods. Univariate and multivariate Cox proportional hazards models were used to assess the prognostic value of different LN staging systems on cause-specific survival (CSS). The relative discriminative abilities of the different LN staging systems were assessed using the Akaike information criterion (AIC) and the Harrell consistency index (HCI). Result: A total of 3,680 patients were diagnosed with SBNETs between 1988 and 2014 from the SEER database. A significant difference over time (1988–1999 vs. 2000–2014) was seen in age ( P <0.001), tumor differentiation ( P <0.001), T stage ( P <0.001), and RLN ( P <0.001) subgroups. Multivariate Cox survival analysis identified that LN status stratified by the number of RLNs, NLNs, LNR, and LODDS all predicted CSS in patients with SBNETs (all P <0.05), whereas the number of positive lymph nodes (PLNs) failed ( P = 0.452). When assessed using categorical variables, LODDS staging systems showed the best prognostic performance (HCI: 0.766, AIC: 7,575.154) in the whole population. Further analysis based on different RLNs after eliminating the missing data showed that when the RLNs are <12, the LODDS (HCI: 0.769, AIC: 1,088.731) maintained the best prognostic performance as well when the RLNs are ≥12 (HCI: 0.835, AIC: 825.692). Among patients with LNR scores of 0 or 1, there was a residual heterogeneity of outcomes that were better stratified and characterized by the LODDS. Conclusion: LODDS was a better predicator of survival when LN status was stratified as a categorical variable and should be considered when assessing the prognosis of patients with SBNETs to allow a more reliable means to stratify patient survival.

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Prognostic impact of a large mesenteric mass >2 cm in ileal neuroendocrine tumors

Cited by 20 publications

References 34 publications

Small Intestinal Neuroendocrine Neoplasm: Factors Associated with the Development of Local Tumor-Related Symptoms

Small Intestinal Neuroendocrine Neoplasm: Factors Associated with the Development of Local Tumor-Related Symptoms

International survey on opinions and use of minimally invasive surgery in small bowel neuroendocrine neoplasms

Prognostic Performance of Different Lymph Node Staging Systems in Patients With Small Bowel Neuroendocrine Tumors

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