Surgical treatment of stage IV gastroenteropancreatic neuroendocrine carcinoma: Experience and outcomes in the United States

Abstract

Background and ObjectivesSurgery for metastatic gastroenteropancreatic neuroendocrine carcinoma (GEP‐NEC) has not been well‐studied. This retrospective cohort study describes patients in the United States with stage IV GEP‐NEC and their survival outcomes segregated by surgery.MethodsPatients diagnosed with stage IV GEP‐NEC from 2004 to 2017 in the National Cancer Database were categorized into three groups: no surgery, primary site or metastatic site (“single‐site”) surgery, and primary site and metastatic site (“multisite”) surgery. Factors associated with surgical treatment were identified, and risk‐adjusted overall survival of each group was compared.ResultsOf 4171 patients included, 958 (23.0%) underwent single‐site surgery and 374 (9.0%) underwent multisite surgery. The strongest predictor of surgery was primary tumor type. Compared with no surgery, the risk‐adjusted mortality reduction associated with single‐site surgery ranged from 63% for small bowel (HR = 0.37, 0.23–0.58, p < 0.001) NEC to 30% for colon and appendix NEC (HR = 0.70, 0.61–0.80, p < 0.001), while the mortality reduction associated with multisite surgery ranged from 77% for pancreas NEC (HR = 0.23, 0.17–0.33, p < 0.001) to 48% for colon and appendix NEC (HR = 0.52, 0.44–0.63, p < 0.001).ConclusionsWe observed an association between extent of surgical intervention and overall survival for patients with stage IV GEP‐NEC. Surgical resection should be further investigated as a treatment option for highly‐selected patients with this aggressive disease.