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Predicting Survival and Response to Treatment in Poorly-Differentiated Neuroendocrine Tumors of the Esophagus and Stomach
ENDOCRINE SURGERY
INTRODUCTION: Poorly-differentiated neuroendocrine tumors (PD-NETs) of the esophagus and stomach are rare, and adequate guidelines do not exist. We aimed to describe the behavior and optimal treatment of these tumors.
RESULTS: The majority of PD-NETs were found in the esophagus and the gastric cardia (281/435, 64.6%). Gastric cardia tumors had similar characteristics to esophageal tumors and were associated with worse overall survival than PD-NETs of the noncardia stomach (median survival 9 vs 14.6 months, p < 0.001). Depth of invasion (HR 2.80, 1.43-5.45) and distant metastases (HR 3.43, 2.17-5.41) were independent predictors of worsened survival. Surgery had the greatest survival benefit for PD-NETs with no additional benefit seen from adjuvant chemotherapy or radiation. In patients not undergoing surgery, there was a modest benefit of chemotherapy in distant disease (2.0 vs 7.0 months, p < 0.001) and radiation in locoregional disease (9.4 vs 12.9 months, p < 0.001).
METHODS: PD-NETs of the stomach (n¼283) and the esophagus (n¼152) were selected from the National Cancer Database (2004-2012). Tumor site, grade, size, depth of invasion, lymph node, and distant metastases were evaluated, and survival analyses were performed with respect to tumor characteristics and treatment variables.
CONCLUSIONS: Esophageal and gastric cardia PD-NETs have worse survival than those of the noncardia stomach. Surgery is the mainstay of treatment with no additional survival benefit to adjuvant chemotherapy or radiation. For unresectable disease, there is a modest benefit to chemotherapy or radiation in selected patients.
Predicting Survival and Response to Treatment in Poorly-Differentiated Neuroendocrine Tumors of the Esophagus and Stomach Katherine D Gray, MD, Maureen D Moore, MD, Suraj Panjwani, MBBS, Cheguevara Afaneh, MD, Thomas J Fahey III, MD, Rasa Zarnegar, MD, FACS New York Presbyterian-Weill Cornell Medicine, New York, NY
S76
http://dx.doi.org/10.1016/j.jamcollsurg.2017.07.728 ISSN 1072-7515/17
INTRODUCTION: Poorly-differentiated neuroendocrine tumors (PD-NETs) of the esophagus and stomach are rare, and adequate guidelines do not exist. We aimed to describe the behavior and optimal treatment of these tumors.
RESULTS: The majority of PD-NETs were found in the esophagus and the gastric cardia (281/435, 64.6%). Gastric cardia tumors had similar characteristics to esophageal tumors and were associated with worse overall survival than PD-NETs of the noncardia stomach (median survival 9 vs 14.6 months, p < 0.001). Depth of invasion (HR 2.80, 1.43-5.45) and distant metastases (HR 3.43, 2.17-5.41) were independent predictors of worsened survival. Surgery had the greatest survival benefit for PD-NETs with no additional benefit seen from adjuvant chemotherapy or radiation. In patients not undergoing surgery, there was a modest benefit of chemotherapy in distant disease (2.0 vs 7.0 months, p < 0.001) and radiation in locoregional disease (9.4 vs 12.9 months, p < 0.001).
METHODS: PD-NETs of the stomach (n¼283) and the esophagus (n¼152) were selected from the National Cancer Database (2004-2012). Tumor site, grade, size, depth of invasion, lymph node, and distant metastases were evaluated, and survival analyses were performed with respect to tumor characteristics and treatment variables.
CONCLUSIONS: Esophageal and gastric cardia PD-NETs have worse survival than those of the noncardia stomach. Surgery is the mainstay of treatment with no additional survival benefit to adjuvant chemotherapy or radiation. For unresectable disease, there is a modest benefit to chemotherapy or radiation in selected patients.
Predicting Survival and Response to Treatment in Poorly-Differentiated Neuroendocrine Tumors of the Esophagus and Stomach Katherine D Gray, MD, Maureen D Moore, MD, Suraj Panjwani, MBBS, Cheguevara Afaneh, MD, Thomas J Fahey III, MD, Rasa Zarnegar, MD, FACS New York Presbyterian-Weill Cornell Medicine, New York, NY
S76
http://dx.doi.org/10.1016/j.jamcollsurg.2017.07.728 ISSN 1072-7515/17