Outcomes of non-metastatic poorly differentiated gastroenteropancreatic neuroendocrine neoplasms treated with surgery: a
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ORIGINAL ARTICLE
Outcomes of non-metastatic poorly differentiated gastroenteropancreatic neuroendocrine neoplasms treated with surgery: a real-world population-based study Omar Abdel-Rahman 1
&
Nuh Rahbari 2 & Christoph Reissfelder 2 & Hani Oweira 2
Accepted: 29 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To assess the outcomes of non-metastatic poorly differentiated gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) treated with radical surgery. Methods Surveillance, Epidemiology, and End Results (SEER) database (1998–2015) was accessed, and patients with nonmetastatic poorly differentiated/undifferentiated GEP-NENs were reviewed. Multivariable Cox regression analysis was used to evaluate factors affecting overall survival (OS) and cancer-specific survival (CSS). Patients treated with radical surgery were matched to those who did not undergo surgery through propensity score matching and Kaplan-Meier survival estimates were used to evaluate the impact of surgery in the post-propensity cohort. Results A total of 1517 patients were included. Within multivariable Cox regression models and compared to no surgery, radical surgery was associated with improved OS (HR: 0.41; 95% CI: 0.34–0.50) and CSS (HR: 0.37; 95% CI: 0.29–0.47). A total of 233 patients who underwent no surgery were then matched to 233 patients who underwent radical surgery. Within the postpropensity cohort, radical surgery was associated with improved OS (P < 0.001). Conclusions Radical surgery is associated with improved survival outcomes in patients with non-metastatic poorly differentiated GEP-NENs. Further studies are required to better identify the best timing of radical surgery within the context of multimodal management. Keywords Surgery . NENs . Outcomes . Prognosis
Introduction Gastroenteropancreatic neuroendocrine neoplasms (GEPNENs) represent a heterogeneous group of neoplasms with diverse biology, presentation, and outcomes [1, 2]. Patients with poorly differentiated GEP-NENs represent an
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s00384-02003793-7. * Omar Abdel-Rahman [email protected] 1
Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta T4G1Z2, Canada
2
Department of Surgery, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
uncommon subset of this disease with limited evidence regarding the best treatment approach [3, 4]. Treatment algorithms for patients with extra-pulmonary poorly differentiated NENs (including GEP-NENs) have generally been based on extrapolation of the available results from treating small cell lung cancer [5]. Therefore, the potential role of surgery within the treatment algorithm of these patients has been questioned [6]. Except for very early cases, radical surgery is not indicated as a part of the standard treatment of small cell lung cancer [7]. Given the differences in biology and presentation between pulmonary an
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