Clinical management of patients with gastric neuroendocrine neoplasms associated with chronic atrophic gastritis: a retrospective, multicentre study

Abstract

To provide data regarding clinical presentation, pathological features, management, and response to different treatments of patients with type I gastric neuroendocrine tumors in stages 0-2A. The study design consist of an Italian multicentre, retrospective analysis of patients with type I gastric neuroendocrine tumors managed with different therapeutic approaches: surgery, endoscopic surveillance, endoscopic resection, or somatostatin analog therapy. Among the 97 patients included, 3 underwent surgery, 45 (46.4%) radical endoscopic resection of the neoplastic lesions, 13 (13.4%) follow-up with upper endoscopy, and 36 (37.1%) somatostatin analog therapy. At the end of the follow-up, all patients were alive and there was no evidence of metastatic disease. Somatostatin analog therapy resulted in a complete response in 76.0% of the patients and stable disease in 24.0%. A prolonged period of therapy, the use of a full dose of somatostatin analogs and higher gastrin levels at diagnosis were related to a complete response to the therapy. The recurrence rate was 26.3% in patients treated with somatostatin analog therapy and 26.2% in patients treated with endoscopic resection, without a statistically significant difference in terms of disease-free survival. Regarding recurrence of the disease, no statistical difference was found according to type of therapy, number of neoplastic lesions, and 2010 WHO classification. The only risk factor for tumor recurrence was a short period of medical treatment. In conclusion, our study suggested that endoscopic surveillance, endoscopic resection and somatostatin analog therapy represent valid options in the management of patients with type I gastric neuroendocrine tumors in stages 0-2A.

Prognostic Evaluations Tailored to Specific Gastric Neuroendocrine Neoplasms: Analysis Of 200 Cases with Extended Follow-Up

“…In our type I NETs, G2 failed to be associated with gastric wall invasion or metastases, despite the fact that an association of grade with tumor behavior as well as patient outcome was ascertained for type III gastric NETs, as well as for pancreatic and duodenal NETs [39-41]. These results bring the attention to previous type I NET series where G2 failed to predict tumor behavior [27, 42] or showed no apparent impact on tumor behavior and patient survival despite a high G2 type I NET percentage (71% reported by Lee et al [29] and 34% by Campana et al [43]).…”

Management of gastric neuro-endocrine tumours in a large French national cohort (GTE)

“…Somatostatin analogues reduce hypergastrinemia and have a direct antiproliferative effect on ECL cells. Although SSA are not yet recommended for types 1 and 2 GNETs, several case reports or cohort studies have reported reduction or disappearance of tumours treated with SSA (25,26,29,30). Even if SSA are considered as an over-treatment for types 1 and 2 GNETs, it is admitted that for selected cases SSA can be used, especially when endoscopic management is not feasible or not accepted by patients (31).…”

Gastric neuroendocrine tumors: management and challenges

“…28,29 Limited studies, including a few small prospective studies, have demonstrated regression or complete disappearance of tumors and marked decrease in serum gastrin, lasting up to several years. [30][31][32][33][34][35][36][37][38][39] SSAs (e.g. octreotide and lanreotide) can be considered in cases in which endoscopic resection is not feasible due to extensive multifocal disease, or submucosal/lymph node involvement, as well as recurrent disease after repeated endoscopic resection.…”