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Introduction: There is no consensus regarding the role of primary tumor resection for patients with metastatic pancreatic neuroendocrine tumors (panNET). We assessed surgical treatment patterns and evaluated the survival impact of primary tumor resection in patients with metastatic panNET.Methods: Patients with synchronous metastatic nonfunctional panNET in the National Cancer Database (2004Database ( −2016 were categorized based on whether they underwent primary tumor resection. We used logistic regressions to assess associations with primary tumor resection. We performed survival analyses with Kaplan−Meier survival functions, log-rank test, and Cox proportional hazard regression within a propensity score matched cohort.Results: In the overall cohort of 2613 patients, 68% (n = 839) underwent primary tumor resection. The proportion of patients who underwent primary tumor resection decreased over time from 36% (2004) to 16% (2016, p < 0.001).After propensity score matching on age at diagnosis, median income quartile, tumor grade, size, liver metastasis, and hospital type, primary tumor resection was associated with longer median overall survival (OS) (65 vs. 24 months; p < 0.001) and was associated with lower hazard of mortality (HR: 0.39, p < 0.001). Conclusion:Primary tumor resection was significantly associated with improved OS, suggesting that, if feasible, surgical resection can be considered for well-selected patients with panNET and synchronous metastasis. | INTRODUCTIONPancreatic neuroendocrine tumors (panNETs) are a rare, but increasingly prevalent, set of neoplasms that may be associated with functional hormonal syndromes, multiple endocrine neoplasia type I, and von-Hippel−Lindau syndrome, among others. 1,2 Among pan-NETs, nonfunctional tumors are not only more prevalent but also diagnosed at more advanced stage, with more than half of patients presenting with metastasis at diagnosis. 3 Patients with distant metastases at diagnosis experience significantly shorter overall

Background and Objectives Adherence to evidence‐based guidelines in gastric cancer is low. We aimed to evaluate adherence to National Comprehensive Cancer Network (NCCN) Guidelines for gastric cancer at both patient‐ and hospital‐levels and examine associations between guideline adherence and treatment outcomes, including overall survival (OS). Methods We applied stage‐specific, annual NCCN Guidelines (2004–2015) to patients with gastric cancer treated with curative‐intent within the National Cancer Database and compared characteristics of patients who did and did not receive guideline‐adherent care. Hospitals were evaluated by guideline adherence rate. We identified associations with OS through multivariable Cox regression. Results Of 37 659 patients included, 32% received NCCN Guideline‐adherent treatment. OS was significantly associated with both guideline adherence (51 months for patients receiving guideline‐adherent treatment vs. 22 for patients receiving nonadherent treatment, p < 0.001). Treatment at a hospital with higher adherence was associated with longer OS (21 months for patients treated at lowest adherence quartile hospitals vs. 37 months at highest adherence quartile hospitals, p < 0.001), regardless of type of treatment received. Conclusions Guideline‐adherent treatment was strongly associated with longer median OS. Guideline adherence should be used as a benchmark for focused quality improvement for physicians taking care of patients with gastric cancer and institutions at large.

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