Pattern and risk factors for distant metastases in gastrointestinal neuroendocrine neoplasms: a population‐based study

Abstract

An increased incidence of gastrointestinal neuroendocrine neoplasms (GI‐NENs) has been reported worldwide, and metastasis is the leading cause of GI‐NEN‐related death. Studies of different metastatic patterns in patients with different primary sites are limited. A population‐based retrospective cohort study was conducted with the Surveillance, Epidemiology, and End Results (SEER) database. Patients with a GI‐NEN diagnosis between 2010 and 2014 were included. All statistical analyses were performed using Intercooled Stata 12.0 software. There were 12,501 patients eligible for analysis. The metastatic status, primary sites, and histology types affected the patients’ overall survival. The liver was the most common metastasis site (65.21% of patients with metastases). Esophageal NENs had the highest risk of metastasis (49.35%), whereas appendiceal NENs had the lowest risk of metastasis (2.79%). Neuroendocrine carcinomas (NECs) were more likely to develop metastatic disease than were neuroendocrine tumors (NETs); 7.12% of patients with NET and 30.20% of patients with NEC developed metastatic disease. The metastatic patterns varied according to the different primary sites and histology types. NECs had a higher potential to develop extrahepatic metastasis at all primary sites than did NETs. Regarding the choice of treatment, surgical resection of primary lesions lowered the risk of tumor‐specific death (HR = 0.37, CI: 0.30–0.46, P < 0.01), but surgical resection of metastatic sites did not confer an extra survival benefit (HR = 0.82, CI: 0.63–1.06, P = 0.14). Different primary sites and histology types of GI‐NENs have different metastatic patterns and survival. This knowledge could help clinicians to identify patients who require extra surveillance, provide insight for future studies on the mechanisms of metastasis, and establish a prognostic prediction model.

Racial/Ethnic Disparities and Survival Characteristics in Non-Pancreatic Gastrointestinal Tract Neuroendocrine Tumors

“…Non-Hispanic White patients had a higher frequency of small intestine and colon neuroendocrine tumors, while non-Hispanic Black patients had a higher rate of rectal neuroendocrine tumors. Our results corroborate results from older studies that showed the small intestine neuroendocrine tumor had a higher rate of metastasis at presentation, while stomach and rectal neuroendocrine tumors were present with localized disease [ 17 ]. Similarly, colon neuroendocrine tumors had higher tumor grade and behaved more aggressively than rectal neuroendocrine tumors.…”

“…Significant factors of survival included age, sex, race, primary tumor site, tumor histology, marital status, tumor size, previous treatments, disease stage, and tumor grade. This confirmed results from a previous analysis that showed worse cause-specific survival in gastrointestinal tract neuroendocrine tumors patients with a lack of insurance, higher tumor grade, greater tumor size, and metastatic disease [ 17 ]. With regard to the racial/ethnic differences on overall survival and cause-specific survival associated with gastrointestinal tract neuroendocrine tumors, we found that Hispanics and non-Hispanic Black patients had better survival outcomes than non-Hispanic White patients.…”

“…These patients were identified based on the International Classification of Diseases, 10th Revision (ICD-10) primary site code, and ICD for Oncology, 3rd edition (ICD-O-3) histology codes. The primary site codes were as follows: esophagus (C15.0–C15.9), stomach (C16.0–C16.9), small intestine (C17.0–C17.9), colon (C18.0–C18.9, C19.9), rectum (C20.9), and appendix (C18.1) [ 17 , 26 ]. ICD-O-3 codes for histology were as follows: 8013, 8041-8045, 8150-8153, 8155-8156, 8240-8242, 8245-8246, and 8249 [ 8 , 11 , 18 , 27 ].…”

Incidence and risk factors of gastrointestinal neuroendocrine neoplasm metastasis in liver, lung, bone, and brain: A population‐based study

“…Previous studies revealed that 13.17% of GI‐NENs were diagnosed at stage IV once metastasis was noticed . Liver is the most common metastatic site of GI‐NENs, followed by the lung, bone and brain .…”

Initial evaluation of dual-energy computed tomography as an imaging biomarker for hepatic metastases from neuroendocrine tumor of the gastrointestinal tract

“…There is, however, little evidence that overall survival has improved for patients with GI NETs (5). The leading cause of death in GI NET cases is hepatic metastases, which are present in 30-80% of patients and represent the most important prognostic factor (7,8).…”