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01-05-2018 | Endocrine Tumors

Predicting Survival and Response to Treatment in Gastroesophageal Neuroendocrine Tumors: An Analysis of the National Cancer Database

Authors: Katherine D. Gray, MD, Maureen D. Moore, MD, Suraj Panjwani, MBBS, Adham Elmously, MD, Cheguevara Afaneh, MD, Thomas J. Fahey III, MD, Rasa Zarnegar, MD

Published in: Annals of Surgical Oncology | Issue 5/2018

Abstract

Background

Neuroendocrine tumors (NETs) of the esophagus and stomach are rare neoplasms with variable behavior. We aim to describe their epidemiology and response to treatment.

Methods

NETs of the stomach and the esophagus were selected from the National Cancer Database (2004–2013) and classified by location. Survival analyses were performed with respect to tumor characteristics and treatment variables.

Results

NETs of the stomach (n = 2700; 92.8%) and esophagus (n = 210, 7.2%) were identified. Gastric cardia NETs had demographics and behavior similar to esophageal tumors and were associated with worse overall survival than NETs of the noncardia stomach independent of grade (p < 0.001). Poorly differentiated histology [hazard ratio (HR) 4.14, 95% confidence interval (CI) 2.26–7.57; p < 0.001] and distant metastases (HR 3.28, 95% CI 1.94–5.56; p < 0.001) were the greatest independent predictors of survival. For patients with poorly differentiated NETs, surgery was the only treatment to have benefit on overall survival (HR 0.38, 95% CI 0.27–0.54; p < 0.001) regardless of extent of disease. There was no additional benefit to adjuvant chemotherapy or radiation in patients undergoing resection (p = 0.39), even for patients with lymph node metastases (surgery alone versus surgery plus adjuvant therapy, p = 0.46), distant metastases (p = 0.19), or positive margins (p = 0.33).

Conclusions

Esophageal and gastric cardia NETs have worse survival than those of the noncardia stomach. Surgery offers the only survival benefit for poorly differentiated tumors, with no additional survival advantage to adjuvant chemotherapy or radiation.

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Title: Predicting Survival and Response to Treatment in Gastroesophageal Neuroendocrine Tumors: An Analysis of the National Cancer Database
Authors: Katherine D. Gray, MD
Maureen D. Moore, MD
Suraj Panjwani, MBBS
Adham Elmously, MD
Cheguevara Afaneh, MD
Thomas J. Fahey III, MD
Rasa Zarnegar, MD
Publication date: 01-05-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 5/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-018-6389-6

At a glance: The STEP trials

Springer Medicine

Predicting Survival and Response to Treatment in Gastroesophageal Neuroendocrine Tumors: An Analysis of the National Cancer Database

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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