Radical Resection in Entero-Pancreatic Neuroendocrine Tumors: Recurrence-Free Survival Rate and Definition of a Risk Score for Recurrence

Abstract

Background. Surgery with radical intent is the only potentially curative option for entero-pancreatic neuroendocrine tumors (EP-NETs) but many patients develop recurrence even after many years. The subset of patients at high risk of disease recurrence has not been clearly defined to date. Objective. The aim of this retrospective study was to define, in a series of completely resected EP-NETs, the recurrence-free survival (RFS) rate and a risk score for disease recurrence. Patients and Methods. This was a multicenter retrospective analysis of sporadic pancreatic NETs (PanNETs) or small intestine NETs (SiNETs) [G1/G2] that underwent R0/R1 surgery (years 2000-2016) with at least a 24-month follow-up. Survival analysis was performed using the Elettra Merola and Andreas Pascher share first authorship.

Prognostic differences in grading and metastatic lymph node pattern in patients with small bowel neuroendocrine tumors

“…The distribution of G1 and G2 tumors among our patient cohort was nearly balanced with 54.5% G1 tumors and 44.7% G2 tumors. Our study confirms earlier findings that patients with G2 tumors display worse OS compared to patients with G1 tumors and show a significantly earlier progression postoperatively ( p = 0.003) [ 14 , 29 ].…”

“…The role of grading (Ki67 index) as a prognostic factor for GEP-NET was validated in several studies [ 14 , 20 , 26 , 27 ]. The distribution of G1 and G2 tumors among our patient cohort was nearly balanced with 54.5% G1 tumors and 44.7% G2 tumors.…”

“…Stages I–III si-NET have an excellent prognosis if R0 resection is attained [ 8 , 15 , 30 ]. Postoperative remaining metastases (R +) are associated with poor OS and remission free survival [ 14 , 38 ]. In our analysis, there was no significant difference between the R1 and R2 group.…”

“…Reliable predictive parameters beside the Ki67 cell proliferation index have yet to be evaluated. In a recent retrospective study, Merola et al introduced a risk score based on proliferative index, resection status (R), and disease extent for G1/G2 GEP NET to predict the risk of recurrence in radically resected patients [ 14 ]. Further, Evers et al characterized factors associated with recurrence in curatively resected locoregional si-NET such as age, tumor size, and lymph node ratio [ 15 ].…”

Outlook for 615 Small Intestinal Neuroendocrine Tumor Patients: Recurrence Risk after Surgery and Disease-Specific Survival in Advanced Disease

“…The ratio of patients with disseminated disease at diagnosis varies from 40 to 75% [ 3 , 11 ]. Due to the slow growth of the tumor, recurrence may occur many years after the surgery [ 12 , 13 ]. Risk factors for disease recurrence include disease stage and proliferation index [ 12 , 13 , 14 ].…”