Which Staging System Is More Suitable for Gastric Neuroendocrine Cancer and Mixed Adenoneuroendocrine Carcinomas? A Multicenter Cohort Study

Abstract

<b><i>Purpose:</i></b> To evaluate whether the European Neuroendocrine Tumor Society (ENETS) system or the 8th American Joint Committee on Cancer (AJCC) staging manual are suitable for gastric neuroendocrine carcinomas and/or mixed adenoneuroendocrine carcinomas (G-NECs/MANECs). <b><i>Methods:</i></b> Patients in a multicentric series with G-NEC/MANEC who underwent curative-intent surgical resection for a primary tumor were included. An optimal staging system was proposed base on analysis of the T and N status and validated by the SEER database. <b><i>Results:</i></b> Compared with the ENETS system, the survival curves of the T category and N category in the 8th AJCC system were better separated and distributed in a more balanced way, but the survival curves of T2 vs. T3, N0 vs. N1, and N3a vs. N3b overlapped. For the T category, the 8th AJCC T category was modified by combining T2 and T3, which was consistent with the T category in the 6th AJCC manual for GC. For the N category, the optimal cut-off values of metastatic lymph nodes using X-tile were also similar to those of the N category in the 6th AJCC system. The Kaplan-Meier plots of the 6th AJCC system showed statistically significant differences between individual substages. Compared with the other 2 classifications, the 6th AJCC system also showed superior prognostic stratification. Similar results were obtained in both multicentric and SEER validation sets. <b><i>Conclusions:</i></b> Compared to the 8th AJCC and ENETS systems, the 6th AJCC staging system for GC is more suitable for G-NEC/MANEC and can be adopted in clinical practice.

Comparison of Survival and Patterns of Recurrence in Gastric Neuroendocrine Carcinoma, Mixed Adenoneuroendocrine Carcinoma, and Adenocarcinoma

“…Two propensity score models were generated for pairwise comparisons JAMA Network Open | Gastroenterology and Hepatology (including gastric neuroendocrine carcinoma vs gastric adenocarcinoma and gastric mixed adenoneuroendocrine carcinoma vs gastric adenocarcinoma). Tumor staging is an important pathological factor associated with the prognosis of gastric neuroendocrine carcinoma, gastric mixed adenoneuroendocrine carcinoma, and gastric adenocarcinoma, 22,23 while age and sex are common clinical factors associated with the prognosis of a tumor. 24,25 Thus, propensity scores were calculated using a logistic regression model, including pathological TNM stage, age, and sex, for all patients.…”

“…1). In terms of treatment, compared with patients with gastric adenocarcinoma, the proportion of total gastrectomy in patients with gastric neuroendocrine carcinoma or gastric mixed adenoneuroendocrine carcinoma was higher (1457 patients [52.3%] vs 291 patients [57.9%] and 231 patients [57.6%]; P < .001), but the number of lymph nodes retrieved was lower (median [IQR], 33 [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] nodes vs 21 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] nodes and 22 [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]…”

Do neuroendocrine carcinomas and mixed neuroendocrine–non-neuroendocrine neoplasm of the gastrointestinal tract have the same prognosis? A SEER database analysis of 12,878 cases

“…Both Lin et al . 7 and van der Veen A et al . 8 found that there was no statistically significant difference in prognosis between gastric MiNEN and gastric NEC patients, but La Rosa et al .…”

“…La Rosa et al 6 reported that patients with GI MiNENs generally had a better prognosis than patients with NECs. Both Lin et al 7 and van der Veen A et al 8 found that there was no statistically significant difference in prognosis between gastric MiNEN and gastric NEC patients, but La Rosa et al 9 observed that gastric MiNEN has a better median overall survival (OS) than patients with pure NECs. As for the colon, the results are also varied.…”

Novel staging for gastric neuroendocrine neoplasms by incorporating the WHO grading into the TNM staging system

“… 11 Another relevant study on gNEC found that compared to the 8th AJCC TNM staging system, the 6th AJCC staging system was more suitable for gNEC. 12 These studies illustrated that the 8th AJCC TNM staging system could not stratify patients with gNENs. Since the 8th AJCC TNM staging system has limitations in stratifying patients with gNENs, and at the same time, gNENs with different tumor grades and characteristics have different prognoses and treatments, 1 , 13 a more robust staging system is needed to accurately predict the prognosis of gNENs patients and assist clinical therapeutic decisions.…”