Treatment of Gastric Neuroendocrine Tumors

Abstract

Background: Gastric neuroendocrine (or gastric carcinoid) tumors have recently been classified into 3 types that differ in biological behavior and prognosis. Although the necessity of type-adapted treatment is widely accepted, it seems inconsistently used in daily practice. Hypothesis: Diagnostic differentiation into various biological types is necessary for an adequate treatment of gastric neuroendocrine tumors. Design: Retrospective study. Setting: University hospital department of surgery. Patients: Twenty-seven patients with a histologically verified gastric neuroendocrine tumor. Main Outcome Measures: A univariate analysis of survival rates with respect to tumor type, tumor biological parameters, and treatment performed was accomplished by applying the Kaplan-Meier estimation method. The log-rank test was used to evaluate the level of significance. Results: The 16 type 1 (59%) and 11 type 3 (41%) gastric neuroendocrine tumors differ in tumor size, histopathologic characteristics, and biological behavior. Nine (56%) of 16 type 1 gastric neuroendocrine tumors were treated by local excision, 8 of these (89%) had persistent atrophic gastropathy during the follow-up period. Five-year cumulative survival of patients with type 1 gastric neuroendocrine tumor was 100% without any progression into malignant phenotype. In contrast, 4 (44%) of 9 locally advanced type 3 gastricneuroendocrinetumorsweretreatedradicallybyextended resection with a 5-year cumulative survival of 75%. Conclusions: Differentiation into 3 biologically distinct tumor types for gastric neuroendocrine tumors is important with respect to therapeutic strategy and prognostic consideration. Correct diagnosis is attainable by using endoscopy, histopathologic characteristics, and laboratory chemical analysis and should precede any treatment. Extended radical surgery of high-risk type 3 tumors is indicated when definitive healing is achievable, whereas type 1 tumors are best treated by endoscopic removal and long-term follow-up.

Prognostic Evaluations Tailored to Specific Gastric Neuroendocrine Neoplasms: Analysis Of 200 Cases with Extended Follow-Up

“…However, given the high heterogeneity in clinico-pathologic and etiologic features of gastric NENs, the question arises as to whether the current prognostic criteria are fully and equally suitable for the evaluation of all such neoplastic diseases, which often imply different patient outcomes and management, even when presenting similar histologic and proliferative patterns [13, 14, 21-23]. Therefore, we focused our study on the three main groups of gastric NENs, i.e., type I HAG-associated NETs ( n = 123 cases), type III sporadic NETs ( n = 34 cases), and pdNECs ( n = 43 cases), to reassess the prognostic role of parameters such as tumor grading, size, gastric wall invasion, or metastatic status which are used to choose the most suitable therapeutic approaches (endoscopic surveillance, endoscopic resection, or surgery of various kinds) for individual patients [13, 19, 24-29].…”

Type I Gastric Carcinoids: A Prospective Study on Endoscopic Management and Recurrence Rate

“…Although most of them showed an indolent behavior of this disease, few cases of regional or distant invasion (liver/lymph node metastases) were described [2,5,9,11,12,13,14,15,16,17,18,19]. …”

“…Somatostatin analogs (SAs) have also been proposed as they decrease tumor growth both in vitro and in vivo [9,23,24,25,26,27]. A further alternative evaluated is the conservative management by serial endoscopic controls and lesion removal; however, among the few studies evaluating this option, most of them are based on small sample sizes, include patients managed by different strategies and in addition to this, recurrence data are scanty [9,11,12,13,17,22,28,29]. Therefore, the aim of our study was to evaluate the clinical outcome (survival and malignant progression) as primary endpoint, and the recurrence rate and risk after endoscopic resection as secondary endpoint, in a consecutive series of prospectively enrolled TIGC patients all managed by endoscopic approach.…”

Management of Neuroendocrine Tumors: A Meeting of Experts from Latin America

“…Wedge or segmental resection is justified in many different clinical scenarios, including when a symptomatic tumor is amenable to surgical control. Endoscopic resection may be indicated otherwise, especially in cases of small, type 1 gastric carcinoids and rectal carcinoids [18,19,20]. Localized gastric type 3 carcinoids, however, are best treated by radical surgery [18], whereas small- and large-cell neuroendocrine carcinomas of the colon and rectum are frequently metastatic upon diagnosis, warranting careful workup [21].…”

“…Endoscopic resection may be indicated otherwise, especially in cases of small, type 1 gastric carcinoids and rectal carcinoids [18,19,20]. Localized gastric type 3 carcinoids, however, are best treated by radical surgery [18], whereas small- and large-cell neuroendocrine carcinomas of the colon and rectum are frequently metastatic upon diagnosis, warranting careful workup [21]. The role of lymphadenectomy in NETs of the gastrointestinal tract and pancreas is currently unclear, although it may improve staging in patients with no evidence of distant metastasis.…”