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Primary Tumor Resection Offers Survival Benefit in Patients with Metastatic Midgut Neuroendocrine Tumors

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Approximately 35% of patients with midgut neuroendocrine tumors (MNET) present with distant metastases. Although successful resection of these metastatic foci improves overall survival (OS), the role of primary tumor resection (PTR) in patients with unresectable metastatic disease is unclear. The aim of this study is to evaluate prevalence and survival impact of PTR in patients with unresectable metastatic MNET.

Patients and Methods

A retrospective cohort study of patients with metastatic MNET was performed using the National Cancer Database (2004–2014). Demographic and clinicopathologic variables were compared between patients who did and did not undergo PTR. Survival analysis was performed using Kaplan–Meier and log-rank tests. Multivariable regression analysis was used to assess factors associated with PTR and all-cause mortality.

Results

The cohort included 4076 patients; 2520 (61.8%) underwent PTR. Patients more likely to undergo PTR were younger and diagnosed earlier, underwent treatment at a nonacademic facility, lived on the West Coast or in the Central USA, and presented with smaller lower-grade small bowel primary tumors. Median OS was improved for patients who underwent PTR compared with those who did not (71 vs. 29 months, p < 0.001). On multivariable analysis, younger age, Black race, higher income, later year of diagnosis, treatment at an academic facility, private insurance, fewer comorbidities, small bowel primary, lower grade, and PTR (hazard ratio 0.63, 95% confidence interval 0.51–0.78, p < 0.001) were associated with lower mortality.

Conclusions

PTR was associated with improved OS. Further study is needed to understand how clinicians select patients for PTR.

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Acknowledgement

The data used in the study are derived from a deidentified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed or the conclusions drawn from these data by the investigator. Dr. Fei Wang is a visiting postdoctoral fellow supported by the program of China Scholarship Council.

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Authors and Affiliations

  1. Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Monica Polcz MD, Gretchen C. Edwards MD, Marcus Tan MBBS, Colleen Kiernan MD, MPH, Carmen C. Solórzano MD, Kamran Idrees MD & Christina E. Bailey MD, MSCI

  2. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Cameron Schlegel MD

  3. Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA

    Fei Wang MD, PhD

  4. Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, People’s Republic of China

    Fei Wang MD, PhD

  5. Division of Surgical Oncology, Department of Surgery, East Carolina University, Greenville, NC, USA

    Alexander Parikh MD, MPH

Authors
  1. Monica Polcz MD
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  2. Cameron Schlegel MD
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  3. Gretchen C. Edwards MD
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  4. Fei Wang MD, PhD
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  5. Marcus Tan MBBS
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  6. Colleen Kiernan MD, MPH
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  7. Carmen C. Solórzano MD
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  8. Kamran Idrees MD
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  9. Alexander Parikh MD, MPH
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  10. Christina E. Bailey MD, MSCI
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Corresponding author

Correspondence to Christina E. Bailey MD, MSCI.

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Polcz, M., Schlegel, C., Edwards, G.C. et al. Primary Tumor Resection Offers Survival Benefit in Patients with Metastatic Midgut Neuroendocrine Tumors. Ann Surg Oncol 27, 2795–2803 (2020). https://doi.org/10.1245/s10434-020-08602-7

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  • DOI: https://doi.org/10.1245/s10434-020-08602-7

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