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. 2019 Dec;8(17):7288-7298.
doi: 10.1002/cam4.2567. Epub 2019 Oct 14.

Incidence and risk factors of gastrointestinal neuroendocrine neoplasm metastasis in liver, lung, bone, and brain: A population-based study

Zhibo Zheng  1 , Chuyan Chen  2 , Lingjuan Jiang  3 , Xingtong Zhou  4 , Xiaoyan Dai  1 , Yimin Song  1 , Yongning Li  1
Affiliations

Incidence and risk factors of gastrointestinal neuroendocrine neoplasm metastasis in liver, lung, bone, and brain: A population-based study

Zhibo Zheng et al. Cancer Med. 2019 Dec.

Abstract

Background: Neuroendocrine neoplasm is a rare solid tumor. Metastatic pattern of the gastrointestinal neuroendocrine neoplasm (GI-NEN) has not been fully explored.

Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database (SEER-9 registry) from 1973 to 2015. Incidence was estimated by Joinpoint regression analyses. Data with additional treatment fields of GI-NEN were extracted from the SEER-18 registry from 1 January 2010 to 31 December 2015. A total of 14 685 GI-NEN patients were included in this study. Statistical analyses were performed with SPSS 25.0, the Intercooled Stata SE 15.0, and GraphPad Prism 7.

Results: Incidence of GI-NENs increased from 0.51 per 100 000 patients in 1973 to 6.20 per 100 000 patients in 2015. Of them, 2003 patients were stage IV GI-NEN at the time of diagnosis, including 1459 (72.84%) patients with liver metastasis, 144 (7.19%) lung metastasis, 115 (5.74%) bone metastasis, and 27 (1.35%) brain metastasis. Esophageal NEN had the highest risk of metastasis (52.68%). The median survival for patients with liver, lung, bone, and brain metastasis was 38, 6, 9, and 2 months, respectively. The presence of lung or liver metastasis indicated higher risk of concurrent existence of bone and brain metastasis than those without.

Conclusion: Bone and brain metastasis should be screened in the GI-NEN patients if they had lung or liver metastasis. Findings of the current study could help clinicians to identify distant metastasis of GI-NENs as early as possible, and by which, to improve survival rate of GI-NENs.

Keywords: SEER; gastrointestinal; metastases; neuroendocrine neoplasms.

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Conflict of interest statement

The authors declared no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the inclusion and exclusion process. Total of 22 440 cases of gastrointestinal neoplasms (GI‐NENs) from SEER database were screened and 14 685 cases were included in the final analysis
Figure 2
Figure 2
Incidence of gastrointestinal neuroendocrine neoplasms (GI‐NENs) from 1973 through 2015. Panel A: Age‐adjusted incidence of GI‐NENs. Panel B: Age‐adjusted incidence of NENs originated from various parts of gastrointestinal tract. (^) P < .05. APC: annual percentage change
Figure 3
Figure 3
Survival analyses of the GI‐NEN patients with liver, lung, bone or brain metastasis. Panel A: Patients with or without liver metastasis, P < .001. Panel B: Patients with or without lung metastasis, P < .001. Panel C: Patients with or without bone metastasis, P < .001. Panel D: Patients with or without brain metastasis, P < .001
Figure 4
Figure 4
Forest plot of multivariate regression analysis for liver metastasis of GI‐NENs. Horizontal axis: Hazard ratio on a log scale with the reference line, Hazard ratios (circle) and 95% CI (whiskers)
See this image and copyright information in PMC

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