Gastric Neuroendocrine Tumors (g-NETs): A Systematic Review of the Management and Outcomes of Type 3 g-NETs

Abstract

Purpose: to collect data from real-life experiences of the management of type 3 g-NETs and identify possible prognostic factors that may impact the decision-making process.

Methods: We performed a systematic review of the literature on type 3 g-NET management using the PubMed, MEDLINE, and Embase databases. We included cohort studies, case series, and case reports written in the English language.

Results: We selected 31 out of 556 articles from between 2001 and 2022. In 2 out of the 31 studies, a 10 mm and 20 mm cut-off size were respectively associated with a higher risk of gastric wall infiltration and/or lymph node and distant metastasis at diagnosis. The selected studies reported a higher risk of lymph node or distant metastasis at diagnosis in the case of muscularis propria infiltration or beyond, irrespective of the dimensions or grading. From these findings, size, grading, and gastric wall infiltration seem to be the most relevant factors in management staff making choices and prognoses of type 3 g-NET patients. We produced a hypothetical flowchart for a standardized approach to these rare diseases.

Conclusion: Further prospective analyses are needed to validate the prognostic impact of the use of size, grading, and gastric wall infiltration as prognostic factors in the management of type 3 g-NETs.

Keywords: gastric NET; neuroendocrine tumors; stomach; type 3.

Figure 1

Flowchart depicting the literature search for the systematic review, in accordance with the PRISMA statement.

Figure 2

Flowchart management in the case of endoscopic type 3 g-NET detection. CT: computer tomography, Ga: gallium, PET: Positron Emission Tomography, FDG: fluorodeoxyglucose, G: grade, R0: absence of microscopic residual of disease, N0: no positive lymph nodes at the radiologic imaging, M0: no distant metastasis at the radiologic imaging, N1: positive lymph nodes at the radiologic imaging, M1: distant metastasis, R1: microscopic residual of disease.