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. 2017 Jan 17;8(3):4935-4947.
doi: 10.18632/oncotarget.13632.

Survival outcomes and surgical intervention of small intestinal neuroendocrine tumors: a population based retrospective study

Lunpo Wu  1   2 , Jianfei Fu  3 , Li Wan  1   2 , Jie Pan  4 , Sanchuan Lai  2   5 , Jing Zhong  1   2 , Daniel C Chung  6 , Liangjing Wang  1   2
Affiliations

Survival outcomes and surgical intervention of small intestinal neuroendocrine tumors: a population based retrospective study

Lunpo Wu et al. Oncotarget. .

Abstract

Background: Small intestinal neuroendocrine tumors (SiNETs) without distant metastasis typically behave in an indolent manner, but there can be heterogeneity. We aimed to define the survival outcomes and impacts of surgical intervention.

Methods: A retrospective cohort study was conducted by using data from the Surveillance, Epidemiology, and End Results (SEER) database. Clinicopathologic features were analyzed in 4407 patients between 2000 and 2012. The cancer specific survival (CSS) was calculated by the Kaplan-Meier method. Multivariable Cox regression models with hazard ratios (HRs) were constructed to analyze survival outcomes and risk factors.

Results: The adjusted incidence of early SiNETs is 1.3/100,000. Tumors are most commonly located in the ileum and are small (≤ 2 cm). The 5-year and 10-year CSS rates were 95.0% and 88.5%, respectively. Age > 50 years, large tumor size (> 2cm), poor differentiation, advanced T classification, and absence of surgical treatment were independent predictors of poor survival. Stratified analysis indicated that surgery significantly improved survival in patients that were white (HR, 0.45), > 50 years old (HR, 0.61), had duodenal tumors (HR, 0.43), large tumors (> 2cm) (HR, 0.32), advanced T classification (T3: HR, 0.29; T4: HR, 0.18) or well differentiation (HR, 0.55). There was no significant survival difference between local resection and radical resection (P =0.884).

Conclusions: Early SiNETs have a favorable prognosis. Surgical resection may improve outcomes, particularly in older patients and those with large tumors. More aggressive resections couldn't improve outcomes.

Keywords: SEER; neuroendocrine tumors; prognostic factors; small intestine; surgical management.

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Conflict of interest statement

CONFLICTS OF INTEREST

None declared

Figures

Figure 1
Figure 1. Trends of age-adjusted incidence of SiNETs, Surveillance, Epidemiology, and End Results registry 2000 to 2012
The incidence is presented as the number of tumors per 100,000 (with 95% CIs) age-adjusted for the US standard population. SiNETs, small intestinal neuroendocrine tumours; CI, confidence interval.
Figure 2
Figure 2. The cancer-specific survival (CSS) curve of patients treated with surgical resection and without surgery
The 5-, 10-year CSS for patients treated with and without surgery were 95.4%, 89.2% and 91.7%, 82.6%, respectively (P =0.001). P value from log-rank test.
Figure 3
Figure 3. Hazard ratios and 95% CIs in different subgroups of surgery and non-surgery (Forest plot analysis)
CI, confidence interval; HR, hazard ratio.
Figure 4
Figure 4. The cancer-specific survival (CSS) curve of patients with local resection (LR) and radical resection (RR)
The 5-, 10-year CSS were 95.0%, 87.2% and 94.7%, 89.6%, for LR and RR, respectively (P =0.844). P value from log-rank test.
Figure 5
Figure 5. Hazard ratios and 95% CIs in different subgroups of LR and RR (Forest plot analysis)
CI, confidence interval; HR, hazard ratio; LR, local resection; RR, radical resection.
Figure 6
Figure 6. Cohort inclusion and exclusion diagram
NOS: not otherwise specified.
See this image and copyright information in PMC

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