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. 2013 Oct 20;31(30):3776-81.
doi: 10.1200/JCO.2013.51.1477. Epub 2013 Sep 16.

Revised staging classification improves outcome prediction for small intestinal neuroendocrine tumors

Michelle Kang Kim  1 , Richard R P Warner, Sasan Roayaie, Noam Harpaz, Stephen C Ward, Steven Itzkowitz, Juan P Wisnivesky
Affiliations

Revised staging classification improves outcome prediction for small intestinal neuroendocrine tumors

Michelle Kang Kim et al. J Clin Oncol. .

Abstract

Purpose: Small intestinal (SI) neuroendocrine tumors (NETs) have heterogeneous outcomes. The NET societies have recently proposed a TNM staging classification. In this study, we used population-based data to assess the validity of the staging system.

Patients and methods: We identified patients with SI-NETS diagnosed between 1988 and 2009 from the Surveillance, Epidemiology, and End Results registry. We used Kaplan-Meier analysis to assess disease-specific survival according to TNM status. Cox models were constructed to evaluate differences in prognosis after controlling for potential confounders.

Results: We identified 6,792 patients with SI-NET. Although the current staging system was predictive of prognosis, there was overlap among some groups (stage I/IIA, P = .36; stage IIB/IIIB, P = .70). Additionally, stage IIIB patients had better survival than stage IIIA patients (P < .001). Adjusted analyses showed similar outcomes for T1 versus T2 disease (hazard ratio [HR], 1.02; 95% CI, 0.63 to 1.66). Patients with T3 (HR, 3.60; 95% CI, 2.28 to 5.69) and T4 (HR, 5.50; 95% CI, 3.42 to 8.86) tumors had significantly worse survival than patients with T1 disease. N1 involvement conferred worse survival in T1 (HR, 3.08; 95% CI, 1.75 to 5.44) and T2 disease (HR, 2.73; 95% CI, 1.84 to 4.07) but not in T3 (HR, 0.99; 95% CI, 0.76 to 1.30) or T4 (HR, 0.98; 95% CI, 0.71 to 1.35) disease. A revised classification showed no overlap in survival across groups.

Conclusion: Progressively more advanced T status is associated with worse SI-NET prognosis. Regional lymph node involvement is a marker of worse survival only among patients with T1 or T2 status. These results suggest that revisions to the current staging classification may be helpful.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
(A) Disease-specific survival stratified by T status. Disease-specific survival was progressively worse with increasing T status (P < .001; T1, blue line; T2, gold line; T3, gray line; T4, red line). (B) Disease-specific survival stratified by N status. Patients with N1 (gold line) involvement had worse disease-specific survival than those with N0 (blue line) disease (P < .001). (C) Disease-specific survival stratified by M status. M1 (blue line; M0, gold line) status was associated with worse neuroendocrine tumor–specific survival (P < .001).
Fig 2.
Fig 2.
Disease-specific survival according to current staging system. There was overlap of survival in patients with stages I and IIA disease (P = .36), as well as in patients with stages IIB and IIIB disease (P = .70). In addition, patients with stage IIIB disease had better survival than those with stage IIIA disease (P < .001). Stage IV patients had the worst survival.
Fig 3.
Fig 3.
Disease-specific survival according to the revised staging classification. There is no overlap of survival among prognostic groups.
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