Survival and Prognostic Factor Analysis of 146 Metastatic Neuroendocrine Tumors of the Mid-Gut

Abstract

Background: Gastrointestinal neuroendocrine tumors (NETs) are heterogeneous neoplasms that vary in mortality according to location of primary tumor and stage of disease. Past analyses of survival suggest a trend towards improving longevity among patients with metastatic mid-gut NETs. Methods: We evaluated all cases of metastatic NETs of the mid-gut seen in our institution between 1999 and 2003, measuring survival from time of diagnosis of distant metastatic disease. Median and 5-year survival rates were estimated using Kaplan-Meier methodology. We assessed the impact of various prognostic factors including age, gender, hepatic cytoreductive surgery, and operative resection of the primary tumor. Results: 146 cases of metastatic mid-gut NETs were identified. The median overall survival was 103 months and the 5-year survival rate was 75%. Most patients (91%) received octreotide therapy. Other medical treatments included hepatic artery embolization, chemotherapy, and peptide receptor radiotherapy. Primary tumor resection was performed in 69% of cases, and hepatic cytoreductive surgery in 22% of cases. A median survival of 95 months was observed among patients who did not undergo cytoreductive surgery. Operative resection of the primary tumor was not associated with a significant survival advantage. Conclusions: Median overall survival is 103 months (8.5 years) in patients with metastatic mid-gut NETs. Among patients who are not candidates for hepatic cytoreductive surgery, median survival is 95 months (7.9 years). Resection of the primary tumor does not appear to be associated with a survival benefit in the metastatic setting.

Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis

“…In European and American referral centers, up to 77 and 91 % of patients with PNETs and intestinal NETs [19][20][21][22] present with distant metastases at initial diagnosis, respectively [13]. In the present Japanese study, patients in whom distant metastases were observed at initial diagnosis accounted for 19.9 % of PNETs and 6.0 % of GI-NETs.…”

Does long-term survival exist in pancreatic adenocarcinoma?

“…As a result, it has become increasingly common to identify pancreatic neuroendocrine tumours, with a detection rate exceeding 80% [10]. Finally, although overall survival for patients with pancreatic neuroendocrine tumours is more favourable than for patients with pancreatic adenocarcinomas, the median overall survival in metastatic disease does not exceed 2-5.8 years [11,12].…”

GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

“…Transduodenal local excision with or without lymph node sampling and pancreaticoduodenectomy are other options for primary treatment of non-metastatic duodenal NETs O2 cm. Nevertheless, the optimal approach remains unclear as the biological behavior of these NETs remains largely unknown (30,31). Although ileum/jejunum NETs often present with metastases at diagnosis, surgical treatment has become increasingly important for their management (32).…”