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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2020

01-05-2020 | Neuroendocrine Tumor | Endocrine Tumors

Surgery with Radical Intent: Is There an Indication for G3 Neuroendocrine Neoplasms?

Authors: Elettra Merola, MD, PhD, Anja Rinke, MD, Stefano Partelli, MD, PhD, Thomas M. Gress, MD, PhD, Valentina Andreasi, MD, Attila Kollár, MD, PhD, Aurel Perren, MD, PhD, Emanuel Christ, MD, PhD, Francesco Panzuto, MD, PhD, Andreas Pascher, MD, PhD, Henning Jann, MD, Ruza Arsenic, MD, Birgit Cremer, MD, Daniel Kaemmerer, MD, Patrizia Kump, MD, Rainer W. Lipp, MD, Abbas Agaimy, MD, Bertram Wiedenmann, MD, PhD, Massimo Falconi, MD, PhD, Marianne E. Pavel, MD, PhD

Published in: Annals of Surgical Oncology | Issue 5/2020

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Abstract

Background

While platinum-based chemotherapy represents the standard treatment for advanced grade 3 (G3) neuroendocrine neoplasms (NENs) according to the European Neuroendocrine Tumor Society guidelines, the role of radical-intended surgery in these patients, as well as the use of adjuvant chemotherapy, are still controversial. The aim of the present work is to describe, in a retrospective series of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) G3, the overall survival (OS) rate and risk factors for death after radical surgery. Secondary aims are the description of median recurrence-free survival (RFS) and of the role of adjuvant chemotherapy.

Patients and Methods

Multicenter analysis of a series of stage I–III GEP-NEN G3 patients receiving radical surgery (R0/R1) with/without adjuvant chemotherapy was performed.

Results

Sixty patients from eight neuroendocrine tumor (NET) referral centers, with median follow-up of 23 months (5–187 months) were evaluated. While 28.6% of cases had NET G3, 71.4% had neuroendocrine carcinoma G3 (NEC G3). The 2-year OS rate after radical surgery was 64.5%, with a statistically significant difference in terms of Ki67 threshold (cut-off 55%, P = 0.03) and tumor differentiation (NEC G3 vs. NET G3, P = 0.03). Median RFS after radical surgery was 14 months, and 2-year RFS rate was 44.9%. Use of adjuvant chemotherapy provided no benefit in terms of either OS or RFS in this series.

Conclusions

Surgery with radical intent might represent a valid option for GEP-NEN G3 patients with locoregional disease, especially with Ki67 value ≤ 55%.
Appendix
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Metadata
Title
Surgery with Radical Intent: Is There an Indication for G3 Neuroendocrine Neoplasms?
Authors
Elettra Merola, MD, PhD
Anja Rinke, MD
Stefano Partelli, MD, PhD
Thomas M. Gress, MD, PhD
Valentina Andreasi, MD
Attila Kollár, MD, PhD
Aurel Perren, MD, PhD
Emanuel Christ, MD, PhD
Francesco Panzuto, MD, PhD
Andreas Pascher, MD, PhD
Henning Jann, MD
Ruza Arsenic, MD
Birgit Cremer, MD
Daniel Kaemmerer, MD
Patrizia Kump, MD
Rainer W. Lipp, MD
Abbas Agaimy, MD
Bertram Wiedenmann, MD, PhD
Massimo Falconi, MD, PhD
Marianne E. Pavel, MD, PhD
Publication date
01-05-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-08049-5

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