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

Elettra Merola^1,2,3, Anja Rinke⁴, Stefano Partelli⁵

¹Department of Gastroenterology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy. elettra.merola@gmail.com.

Annals of Surgical Oncology

|November 14, 2019

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Summary

Radical surgery may be a viable option for advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) G3, particularly for tumors with a Ki67 index of 55% or lower. Adjuvant chemotherapy did not show significant benefits in overall survival or recurrence-free survival in this patient group.

Area of Science:

Oncology
Gastroenterology
Surgical Oncology

Background:

Advanced grade 3 (G3) neuroendocrine neoplasms (NENs) typically receive platinum-based chemotherapy.
The roles of radical surgery and adjuvant chemotherapy for GEP-NEN G3 are debated.

Purpose of the Study:

To evaluate overall survival (OS) and risk factors for death in GEP-NEN G3 patients undergoing radical surgery.
To assess recurrence-free survival (RFS) and the impact of adjuvant chemotherapy.

Main Methods:

Retrospective multicenter analysis of stage I-III GEP-NEN G3 patients treated with radical surgery (R0/R1).
Patients received either surgery alone or surgery with adjuvant chemotherapy.

Main Results:

The 2-year OS rate after radical surgery was 64.5%.

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Significant differences in OS were observed based on Ki67 threshold (≤55%) and tumor differentiation (NET G3 vs. NEC G3).

Median RFS was 14 months, with a 2-year RFS rate of 44.9%. Adjuvant chemotherapy did not improve OS or RFS.

Conclusions:

Radical surgery can be a valid treatment for locoregional GEP-NEN G3.
Patients with Ki67 ≤55% may particularly benefit from radical surgical intent.