Clinicopathological characteristics and prognosis of 77 cases with type 3 gastric neuroendocrine tumours

Abstract

BACKGROUND For the rarity of type 3 gastric neuroendocrine tumours (g-NETs), their clinicopathological characteristics and prognosis are not well illustrated. AIM To describe the clinicopathological features and outcome of type 3 g-NETs in the Chinese population. METHODS Based on the 2019 WHO pathological classification, the clinicopathological characteristics and prognosis of patients with type 3 g-NETs in China were retrospectively analysed. RESULTS A total of 77 patients (55.8% of females) with type 3 g-NETs were analysed, with a median age of 48 years (range: 28-79 years). The tumours were mainly located in the gastric fundus/body (83.1%) and were mostly solitary (83.1%), with a median size of 1.5 cm (0.8-3.5 cm). Of these, there were 37 G1 tumours (48.1%), 31 G2 (40.3%), and 9 G3 (11.7%). Ten (13.0%) and 24 (31.2%) patients had lymph node and distant metastasis, respectively. In addition, type 3 g-NETs were heterogeneous. Compared with G1 NETs, G2 NETs had a higher lymph node metastasis rate, and G3 NETs had a higher distant metastasis rate. G1 and G2 NETs with stage I/II disease (33/68) received endoscopic treatment, and no tumour recurrence or tumour-related death was observed within a median follow-up time of 36 mo. Grade and distant metastasis were identified to be independent risk factors for prognosis in multivariable analysis. CONCLUSION Type 3 g-NETs are obviously heterogeneous, and the updated WHO 2019 pathological classification may be used to effectively evaluate their biological behaviors and prognosis. Also, endoscopic treatment should be considered for small (< 2 cm), low grade, superficial tumours.

Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Only one in 121 patients developed a metastasis during follow-up. Type 3 g-NENs may therefore be candidates for endoscopic resection if they are < 20 mm, show only submucosal invasion, and have a negative gallium-68 dotatoc scan beforehand [92][93][94].…”

Gastric Neuroendocrine Tumors (g-NETs): A Systematic Review of the Management and Outcomes of Type 3 g-NETs

“…In 21 studies, the origin of the tumor site was predominantly the gastric corpus/fundus (83.3%) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ], and prevalent polypoid morphology from endoscopy was identified in 13 out of the 31 studies [ 15 , 16 , 17 , 20 , 21 , 22 , 23 , 25 , 26 , 28 , 29 , 30 , 31 ]. A total of 17 out of the 31 studies included tumor depth invasion data, resulting in an invasion that included the submucosa in most cases [ 15 , 16 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 28 , 30 , 32 , 34 , 35 , 36 , 37 , 38 ]. A total of 26 out of the 31 papers reported dimensional data, and the median size was 16.5 mm (8–62.5 mm) [ 14 ,…”

“…A total of 26 out of the 31 papers reported dimensional data, and the median size was 16.5 mm (8–62.5 mm) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 23 , 24 , 26 , 28 , 31 , 32 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Six out of thirty-one authors reported a cut-off size of >10 mm for low tumor-related death [ 16 , 17 , 18 , 19 , 21 , 39 ], while 7 out of the 31 papers reported a larger cut-off size of >20 mm for an increased risk of gastric wall infiltration, metastasis at diagnosis, and relapse ( p < 0.001) [ 14 , 22 , 23 , 24 , 26 , 43 , 44 ]. A total of 3 out of the 31 authors showed a higher risk of gastric wall infiltration (and then lymph node and distant metastasis at diagnosis) with a cut-off of >17 and >19 mm [ 30 , 37 , 38 ], while two authors shared a stricter cut-off of <5 mm for sharing an indication of endoscopic management [ 37 , 39 ].…”

“…Grading was defined in 25 studies (n = 648): G1 type 3 g-NETs = 298 (46%), while G2/G3 = 350 (54%) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 33 , 35 , 36 , 37 , 39 , 41 , 43 , 46 ], with a mean Ki-67 of 18.2% (reported in 15 out of the 31 studies) [ 15 , 16 , 17 , 21 , 22 , 24 , 25 , 26 , 29 , 33 , 36 , 37 , 39 , 41 , 46 ]. Lymph node and distant metastasis at diagnosis were reported in 22 studies, with 27.9% of the patients having lymph node metastasis [ 14 , 15 , 16 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 34 , …”

Clinicopathological features, endoscopic features, and treatment analysis of gastric neuroendocrine neoplasms

“…Type III gNENs have always been considered to be invasive tumors. In a retrospective analysis of 77 patients with type III gNENs, Li et al [ 5 ] found lymph node metastases and distant metastases in ten (13.0%) patients with G2 gNENs, and 24 (31.2%) patients with G3 gNENs. In this study, two patients with type III gNENs were found to have liver metastases, including one case of G2 and one case of G3.…”