High-Grade Gastrointestinal Neuroendocrine Carcinomas: Multidisciplinary Approach Can Improve Survival Outcomes

Area of Science:

• Gastroenterology
• Oncology
• Pathology

Background:

• Limited evidence exists on the presentation and outcomes of high-grade gastrointestinal neuroendocrine carcinomas (HG-NEC).
• Understanding HG-NEC patterns is crucial for improving patient management and survival.
• Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors with varying clinical behaviors.

Purpose of the Study:

• To analyze the presentation patterns and outcomes of patients diagnosed with high-grade gastrointestinal neuroendocrine carcinomas (HG-NEC).
• To evaluate prognostic parameters and overall survival (OS) in a cohort of HG-NEC patients.
• To determine the impact of multidisciplinary tumor (MDT) board decisions on treatment strategies and patient outcomes.

Main Methods:

• Retrospective analysis of 336 patients diagnosed with HG-NEC between May 2014 and May 2022.
• Inclusion criteria: pathological diagnosis of neuroendocrine cancer, gastrointestinal epicenter, and Molecular Immunology Borstel-1 index ≥ 20%.
• Overall survival (OS) estimated using the Kaplan-Meier method; prognostic factors assessed.

Main Results:

• The majority of patients (84%) received cancer-directed treatment; 16% received best supportive care.
• Common primary sites included gallbladder (45%), colorectal (19%), and pancreas (13%). Most patients (75%) had metastatic disease.
• Median OS for the cohort was 15.8 months. MDT classification (resectable, unresectable, metastatic) and multimodality therapy (resection + systemic therapy) significantly improved OS.

Conclusions:

• Most patients with HG-NEC present with advanced disease requiring prompt therapeutic strategies.
• Multidisciplinary tumor (MDT) board evaluation is essential for optimal treatment planning in HG-NEC.
• Multimodality therapy, combining resection and systemic therapy, leads to improved overall survival in HG-NEC patients.