Well-Differentiated Neuroendocrine Neoplasia: Relapse-Free Survival and Predictors of Recurrence after Curative Intended Resections

Abstract

Background: Resection with curative intention is the cornerstone of treatment in patients with neuroendocrine tumors. A proportion of patients will relapse after R0 resection, but the factors predictive of recurrence are not well understood. Methods: A database established 1998 at the University Hospital Marburg was queried for all patients with documented R0 resection. Recurrence-free survival and overall survival were estimated using the Kaplan-Meier method. Uni- and multivariate analyses were performed. Results: 180 patients with a median age of 52 years entered the analysis. We observed 77 recurrences after a median time of 2.9 years. 24% of the recurrences occurred later than 5 years after operation. Median recurrence-free survival of the whole cohort was 101 months. In univariate analysis grade by Ki-67, stage, high lymph node ratio and microangioinvasion were significant predictors of recurrence. On multivariate analysis these parameters were confirmed as independent prognostic parameters with stage and microangioinvasion being the most important predictors. Conclusions: After R0 resection of neuroendocrine tumors, postoperative surveillance should be extended to at least 10 years. Patients with distant metastases and microangioinvasion are at high risk of recurrence. Clinical trials of adjuvant treatment protocols are indicated in these patients.

Nomogram predicting the risk of recurrence after curative‐intent resection of primary non‐metastatic gastrointestinal neuroendocrine tumors: An analysis of the U.S. Neuroendocrine Tumor Study Group

“…39 In a separate study, Dieckhoff et al reported that lymph node ratio (LNR) was a more precise method to predict outcome rather than simple lymph node status. 47 51 In the current study, the proposed nomogram demonstrated good ability to predict 3-, 5-, and 10-year recurrence in both the training and test set. In addition, the nomogram groupings were associated with timing and patterns of recurrence.…”

“…In a separate study, Dieckhoff et al reported that lymph node ratio (LNR) was a more precise method to predict outcome rather than simple lymph node status . In this analysis, patients with a LNR >0.2 had a 5‐year DFS of 46% versus 76% for patients with a LNR ≤0.2 . Similarly, Martin et al reported an increased risk of death of 1.5‐, 2‐, and 3‐fold for patients with LNR ≤0.2 (HR, 1.5), LNR 0.2‐0.5 (HR, 2.0), and LNR >0.5 (HR, 3.1), respectively, compared with patients without nodal metastasis .…”

“…Analyzing clinico‐pathologic factors associated with recurrence in 188 patients who underwent surgery for GEP‐NET, Slatger et al reported that lymph node involvement was an important independent risk factor for recurrence (HR 2.61; 95%CI, 1.17‐5.83) . In a separate study, Dieckhoff et al reported that lymph node ratio (LNR) was a more precise method to predict outcome rather than simple lymph node status . In this analysis, patients with a LNR >0.2 had a 5‐year DFS of 46% versus 76% for patients with a LNR ≤0.2 .…”

“…While prognostic factors associated with recurrence after resection of GEP‐NET have been reported in the literature, data regarding patterns of recurrence are scarce . Using the Surveillance, Epidemiology, and End Results (SEER) and Medicare databases, Shen et al analyzed patterns of recurrence after surgical resection among 2366 patients with non‐metastatic NETs.…”

The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Medical Management of Midgut Neuroendocrine Tumors

“…The results of studies assessing outcomes in several databases suggest that long-term recurrence rates are approximately 50%. 6,7 Due to the slow-growing nature of most midgut NETs, metastatic recurrences can occur many years after surgical resection; prospective studies evaluating surveillance strategies have not been performed. There was consensus among panel members that surveillance should continue beyond 5 years.…”