Lymph Node Metastasis in the Prognosis of Gastroenteropancreatic Neuroendocrine Tumors

Abstract

Objectives This study aimed to determine the prognostic utility of the extent of lymph node involvement in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) by analyzing population-based data. Methods Patients in the Surveillance, Epidemiology, and End Results (SEER) registry were identified with histologically confirmed, surgically resected GEP-NETs. We divided patients into three lymph node ratio (LNR) groups based on the ratio of positive lymph nodes to total lymph nodes examined: ≤0.2, >0.2–0.5, and >0.5. Disease-specific survival was compared according to LNR group. Results We identified 3,133 patients with surgically resected GEP-NETs. Primary sites included stomach (11% of the total), pancreas (30%), colon (32%), appendix (20%), and rectum (7%). Survival was worse in patients with LNRs of ≤0.2 (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.2–2.0), >0.2–0.5 (HR, 2.0; 95% CI, 1.6–2.5), and >0.5 (HR, 3.1; 95% CI, 2.5–3.9) compared to N0 patients. Ten-year disease-specific survival decreased as LNR increased from N0 (81%) to ≤0.2 (69%), >0.2–0.5 (55%), and >0.5 (50%). Results were consistent for patients with both low and high grade tumors from most primary sites. Conclusions Degree of lymph node involvement is a prognostic factor at the most common GEP-NET sites. Higher LNR is associated with decreased survival.

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

“…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 . In the current analysis, the number of metastatic nodes was also strongly associated with the risk of recurrence on both univariable and multivariable analyses.…”

“…While data on overall survival has more commonly been reported, the risk of recurrence following curative resection of primary NET has been less defined. Specifically, data on recurrence after resection, including incidence of recurrence, recurrence pattern and prognostic factors associated with recurrence, remain relatively scarce . Data on recurrence is, however, important to inform patients about the likelihood of treatment success and the risk of recurrence following surgical intervention.…”

“…Specifically, data on recurrence after resection, including incidence of recurrence, recurrence pattern and prognostic factors associated with recurrence, remain relatively scarce. 4,[8][9][10][11] Data on recurrence is, however, important to inform patients about the likelihood of treatment success and the risk of recurrence following surgical intervention. In particular, accurate individual patient-based estimates of risk of recurrence may not only assist with patient counseling and inform decision-making, but also help guide follow-up.…”

New lymph node staging for rectal neuroendocrine tumors

“…This binary staging differs from lymph node staging for almost all other solid tumors such as rectal adenocarcinomas, which have multiple categories based on the number of lymph nodes involved . Previous studies have shown that the number of positive lymph nodes is linked with NET prognosis . However, no studies to date have evaluated the independent prognostication for lymph node positivity in rectal NETs.…”

Prognostic nomogram based on the metastatic lymph node ratio for gastric neuroendocrine tumour: SEER database analysis

“…These tumours are biologically heterogeneous, and outcomes can similarly vary, depending on the status of tumours. 16 To the best of our knowledge, for g-NET, this is the first study to include treatment strategies (surgery, chemotherapy and radiotherapy) into prognostic analysis and nomograms. Considering the importance of LNR, we included LNR in the nomogram.…”