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Gastroenteropancreatic neuroendocrine tumor recurrence often occurs late
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Disease recurrence occurs significantly later for patients with gastroenteropancreatic neuroendocrine tumors compared with other gastrointestinal cancers, according to a research letter published in JAMA Oncology.
“Gastroenteropancreatic neuroendocrine tumors are widely heterogeneous malignant abnormalities. Their natural history is poorly described, with little understanding of recurrence patterns,” Simron Singh, MD, MPH, medical oncologist and affiliate scientist of Odette Cancer Centre at Sunnybrook Research Institute in Toronto, and colleagues wrote.
“Current guidelines vary widely in recommendations, reflecting the lack of data,” they added. “Information on the natural history and recurrence of the disease may improve patient-centered follow-up of this population.”
The researchers performed a cohort study of patients who had first-resected gastroenteropancreatic neuroendocrine tumors between 1994 and 2012 in Ontario, Canada (n = 936; 51.3% women; median age at diagnosis, 60 years). Singh and colleagues reviewed information on patients’ demographics, curative surgeries, recurrence, use of imaging, histological diagnoses and death. Researchers also grouped patients by primary tumor site, describing them as having either small intestinal neuroendocrine tumors, pancreatic neuroendocrine tumors or neuroendocrine tumors of other sites. The most common tumor sites included small intestine (46.6%) and pancreatic neuroendocrine tumors (20%).
Median follow-up was 46.8 months.
Researchers reported a 3-year OS rate of 92.2%, 5-year OS rate of 85.4% and 10-year OS rate of 68.1%.
Significant differences in survival occurred across sites of origin (log-rank P = .04). For instance, at 10 years, OS was 66.9% for small intestinal neuroendocrine tumors and 74.2% for pancreatic neuroendocrine tumors.
Cumulative incidence of recurrence was 23.3% at 3 years compared with 33.5% at 5 years and 48.5% at 10 years. Recurrence occurred earliest among patients who had pancreatic neuroendocrine tumors (Gray’s test for equality of cumulative incidence function P < .001).
The researchers acknowledged limitations to the study included a lack of detailed pathological data, such as Ki-67 index and lymph node status.
“Disease recurrence occurs much later than most other gastrointestinal tract cancers, and patients with pancreatic neuroendocrine tumors recur earlier than those with small intestine neuroendocrine tumors. ... Future research should focus on the cost-effectiveness of surveillance and its impact on patient outcomes,” Singh and colleagues wrote. “These data can inform guidelines for surveillance in this population that accounts for the natural history of this disease.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
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