Exp Clin Endocrinol Diabetes 2015; 123 - P03_32
DOI: 10.1055/s-0035-1547658

Gastric neuroendocrine neoplasias – Outcome predictors – ENETS staging and grading system and treatment

S Felder 1, H Jann 1, U Gerlach 2, A Pascher 2, T Denecke 3, R Pschowski 1, V Prasad 4, R Arsenic 5, B Wiedenmann 1, M Pavel 1, UF Pape 1
  • 1Medizinische Klinik für Hepatologie und Gastroenterologie (Einschl. Arbeitsbereich Stoffwechselerkrankungen); Charité – Universitätsmedizin; Campus Virchow Klinikum
  • 2Klinik für Allgemein-, Visceral- und Transplantationschirurgie; Charité – Universitätsmedizin; Campus Virchow Klinikum
  • 3Klinik für Radiologie; Charité – Universitätsmedizin; Campus Virchow Klinikum
  • 4Klinik für Nuklearmedizin; Charité – Universitätsmedizin; Campus Virchow Klinikum
  • 5Institut für Pathologie; Charité – Universitätsmedizin; Campus Charité Mitte

Rationale: In the light of new therapeutic modalities for advanced NEN detailed analysis of gNEN is in fact rare but important to guide management decisons. This analysis was performed to characterize gNEN, identify prognostic factors, analyze therapeutic modalities and to determine clinical outcome.

Methods: A retrospective analysis gNEN treated in our institution between 1988 until 2014 was performed. Descriptve analysis, statistics and survival analysis were performed using SPSS 19.0.

Results: Of 141 cases 85 (61%) were type-1, 7 (0.5%) type-2, 24 (17%) type-3 and 24 (17%) type-4 gNEN. 55% were female, mean age at diagnosis was 58 years. WHO-grading was G1 in 49%, G2 in 31% and G3 in 20%. cTNM-stage was 0 in 18%, I in 43%, II in 12%, III in 8% and IV in 20%; pTNM staging (93% of cTNM-stages) was comparable. While 1/85 type-1 was metastatic, there were 20/24 (42%) stage IV in type-3 and 15/24 (63%) in type-4 gNEN. Median overall survival was significantly different between all types of gNEN (not reached in type-1, 8.9 in type-3 and 2.9 years in type-4 gNEN), between stages 0/I, II/III and IV (17.1, 10.9, 2.9 years) and between gNET-G1/2 and gNEC-G3 (3.0 years; p < 0.001). Resection, either surgical (SR, 43/33%) or endoscopic (ER, 93/69%), resulted in 5-&10-year survival rates (YSR) of 62&54% in SR and 89&72% in ER with siginificantly better results in curative resections (5-YSR: SR 87%). Chemotherapy (CTx) was frequently used in metastatic type-3 gNET (57%) and type-4 gNEC (95%) resulting in 2- and 5-YSR of 78 and 40%.

Conclusions: These data demonstrate the prognostic role of clinicopathologic, WHO and TNM-staging of gNEN and the significant influence of both curative resection in early treatment as well as palliative chemotherapy in advanced disease.