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Resection of Primary Gastrointestinal Neuroendocrine Tumor Among Patients with Non-Resected Metastases Is Associated with Improved Survival: A SEER-Medicare Analysis.

Authors
  • Tsilimigras, Diamantis I1
  • Hyer, J Madison1
  • Paredes, Anghela Z1
  • Ejaz, Aslam1
  • Cloyd, Jordan M1
  • Beane, Joal D1
  • Dillhoff, Mary1
  • Tsung, Allan1
  • Pawlik, Timothy M2
  • 1 Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA.
  • 2 Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA. [email protected]
Type
Published Article
Journal
Journal of Gastrointestinal Surgery
Publisher
Springer-Verlag
Publication Date
Sep 01, 2021
Volume
25
Issue
9
Pages
2368–2376
Identifiers
DOI: 10.1007/s11605-020-04898-8
PMID: 33403563
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The objective of this study was to analyze whether primary tumor resection (PTR) among patients with stage IV gastrointestinal neuroendocrine tumor (GI-NET) and unresected metastases was associated with improved outcomes. Patients diagnosed with stage IV GI-NETs were identified in the linked SEER-Medicare database from 2004 to 2015. Overall survival (OS) of patients who did versus did not undergo PTR was examined using bivariate and multivariable cox regression analysis as well as propensity score matching (PSM). Among 2219 patients with metastatic GI-NETs, 632 (28.5%) underwent PTR, whereas 1587 (71.5%) did not. The majority of individuals had a NET in the pancreas (n = 969, 43.6%); the most common site of metastatic disease was the liver (n = 1064, 47.9%). Patients with stage IV small intestinal NETs most frequently underwent PTR (62.6%) followed by individuals with colon NETs (56.5%). After adjusting for all competing factors, PTR remained independently associated with improved OS (HR = 0.65, 95% CI: 0.56-0.76). Following PSM (n = 236 per group), patients who underwent PTR had improved OS (median OS: 1.3 years vs 0.8 years, p = 0.016). While PTR of NETs originating from stomach, small intestine, colon, and pancreas was associated with improved OS, PTR of rectal NET did not yield a survival benefit. Primary GI-NET resection was associated with a survival benefit among individuals presenting with metastatic GI-NET with unresected metastases. Resection of primary GI-NET among patients with stage IV disease and unresected metastases should only be performed in selected cases following multi-disciplinary evaluation. © 2021. The Society for Surgery of the Alimentary Tract.

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