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Association between surveillance imaging and survival outcomes in small bowel neuroendocrine tumors
Akie Watanabe1, Geoffrey Mckendry1, Lily Yip1
1Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Background:
Surveillance guidelines following the resection of small bowel neuroendocrine tumors (SB-NETs) are inconsistent. We evaluated the impact of surveillance imaging on SB-NET recurrence and overall survival (OS).
Methods:
Patients with completely resected SB-NETs referred to a provincial cancer center (2004-2015) were reviewed. Associations between imaging frequency, recurrence, post-recurrence treatment, and OS were determined using univariate and Cox-regression analyses.
Results:
Among 195 completely resected SB-NET patients, 31% were ≥70 years, 43% were female, and 80% had grade 1 disease. Imaging frequency was predictive of recurrence (hazard ratio 2.52, 95% confidence interval 1.84-3.46, p < 0.001). 72% underwent interventions for recurrent disease. Patients who were treated for the recurrent disease had comparable OS to those who did not recur (median 152 vs. 164 months; p = 0.25). Imaging frequency was not associated with OS in those with treated recurrent disease (p = 0.65). Patients who recurred underwent more computerized tomography (CT) scans than those who did not recur (CT: 1.47 ± 0.89 vs. 1.02 ± 0.81 scans/year, p < 0.001). Detection of disease recurrence was 5%-7% per year during the first 6 years of surveillance and peaked at 17% in Year 9.
Conclusion:
Less frequent imaging over a longer duration should be emphasized to capture clinically relevant recurrences that can be treated to improve OS.
Insights
Frequent surveillance imaging after small bowel neuroendocrine tumor (SB-NET) resection predicts recurrence but not overall survival. Less frequent, longer-duration imaging may optimize detection of treatable recurrences.
Area of Science:
- Oncology
- Gastroenterology
- Medical Imaging
Background:
- Inconsistent surveillance guidelines exist for small bowel neuroendocrine tumors (SB-NETs) post-resection.
- The impact of surveillance imaging on recurrence and survival remains unclear.
Purpose of the Study:
- To evaluate the association between surveillance imaging frequency and recurrence rates in SB-NET patients.
- To determine if surveillance imaging impacts overall survival (OS) in SB-NET patients.
- To identify optimal surveillance strategies for SB-NETs.
Main Methods:
- Retrospective review of 195 patients with completely resected SB-NETs (2004-2015).
- Analysis of associations between imaging frequency, recurrence, post-recurrence treatment, and OS using univariate and Cox-regression models.
- Comparison of imaging frequency (including CT scans) between patients with and without recurrence.
Main Results:
- Higher imaging frequency predicted SB-NET recurrence (HR 2.52, p<0.001).
- Patients treated for recurrence had similar OS to those without recurrence (median 152 vs. 164 months, p=0.25).
- Imaging frequency did not influence OS in patients with treated recurrence (p=0.65).
- Recurrent disease detection peaked at 17% in Year 9.
- Patients with recurrence underwent more CT scans (1.47/year) than those without (1.02/year).
Conclusions:
- Surveillance imaging frequency is linked to recurrence detection but not overall survival.
- Less frequent, longer-duration surveillance may be more effective for capturing clinically relevant, treatable recurrences.
- Current surveillance strategies may require adjustment to balance detection rates with patient outcomes.
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