Resection of the Primary Tumor Improves the Survival of Patients With Stage IV Gastric Neuroendocrine Carcinoma

Abstract

BackgroundThe prognostic prolongation effect of surgical resection in the management of gastric neuroendocrine carcinoma (GNEC) with distant metastases was still uncertain. The purpose of this study was to investigate the association of primary tumor resection (PTR) with outcomes in patients with stage IV GNEC.MethodsThis retrospective study analyzed patients with distant metastatic GNEC diagnosed between 2000 and 2018 and identified using the Surveillance, Epidemiology, and End Results (SEER) database. Patients were divided into PTR and non-PTR groups. The stabilized inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. Overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan–Meier method and log-rank test. Cox-regression analyses (uni- and multivariate) were performed to evaluate factors potentially influencing survival.ResultsA total of 126 patients with a median follow-up of 79 months were identified. Forty-four patients underwent PTR and 82 patients did not undergo surgery. After the IPTW approach, PTR improved the OS in patients with stage IV GNEC (median OS 12 vs. 6 months, P = 0.010). The 1- and 3-year OS for patients with or without PTR were 43.8% and 34.5%, and 27.9% and 6.5%, respectively. The median CSS was 12 months for patients undergoing PTR and 6 months for those who did not. The 1 and 3-year CSS for patients with or without PTR were 45.1% and 37.0%, and 27.9% and 6.5%, respectively. In IPTW-adjusted Cox proportional hazards regression analysis, PTR was recognized as an independent factor for improved survival after the occurrence of distant metastatic disease [OS: hazard ratio (HR) = 0.305; 95% confidence interval (CI): 0.196, 0.475; and CSS: HR = 0.278; 95% CI: 0.171, 0.452].ConclusionPTR for stage IV GNEC contributes to a better prognosis compared with non-surgery. This study supported the resection of the primary tumor in patients with distant metastatic GNEC.

The impact of surgical resection on prognosis in gastric neuroendocrine tumors

“…It has been shown that primary tumor resection contributes to a better prognosis compared to non-surgical treatment in patients with Stage IV gastric NECs. 28 However, the mortality rate was higher in patients with NECs. This is consistent with patients with NECs having a worse prognosis.…”

Favorable response to PD-1 inhibitor plus chemotherapy as first-line treatment for metastatic gastric mixed neuroendocrine-non-neuroendocrine tumor: a case report

“…Due to its rarity, there is currently no standard treatment. Surgery remains by far the most important treatment option, and studies have shown that even patients with advanced disease may benefit from palliative primary tumor resection ( Li et al, 2022 ). However, the recurrence rate after radical surgery is as high as 45.7% ( Lin et al, 2021 ).…”

Surgical treatment of stage IV gastroenteropancreatic neuroendocrine carcinoma: Experience and outcomes in the United States

“…Another study by Cai et al of patients with colorectal NECs metastatic to the liver found that primary site surgery was associated with decreased mortality for both right‐sided and left‐sided primaries 14 . Finally, a study of the Surveillance, Epidemiology, and End Results (SEER) database by Li et al found resection of the primary tumor to improve survival in patients with metastatic gastric NEC 41 …”