Primary Tumor Resection Offers Survival Benefit in Patients with Metastatic Midgut Neuroendocrine Tumors

Background Approximately 35% of patients with midgut neuroendocrine tumors (MNET) present with distant metastases. Although successful resection of these metastatic foci improves overall survival (OS), the role of primary tumor resection (PTR) in patients with unresectable metastatic disease is uncl...

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Bibliographic Details
Published in:Annals of surgical oncology 2020-08, Vol.27 (8), p.2795-2803
Main Authors: Polcz, Monica, Schlegel, Cameron, Edwards, Gretchen C., Wang, Fei, Tan, Marcus, Kiernan, Colleen, Solórzano, Carmen C., Idrees, Kamran, Parikh, Alexander, Bailey, Christina E.
Format: Article
Language:English
Subjects:
Gastrointestinal Oncology
Humans
Intestinal Neoplasms - surgery
Medicine
Medicine & Public Health
Metastases
Metastasis
Midgut
Mortality
Neuroendocrine tumors
Neuroendocrine Tumors - surgery
Oncology
Proportional Hazards Models
Retrospective Studies
Small intestine
Stomach Neoplasms - surgery
Surgery
Surgical Oncology
Survival
Survival analysis
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Summary:Background Approximately 35% of patients with midgut neuroendocrine tumors (MNET) present with distant metastases. Although successful resection of these metastatic foci improves overall survival (OS), the role of primary tumor resection (PTR) in patients with unresectable metastatic disease is unclear. The aim of this study is to evaluate prevalence and survival impact of PTR in patients with unresectable metastatic MNET. Patients and Methods A retrospective cohort study of patients with metastatic MNET was performed using the National Cancer Database (2004–2014). Demographic and clinicopathologic variables were compared between patients who did and did not undergo PTR. Survival analysis was performed using Kaplan–Meier and log-rank tests. Multivariable regression analysis was used to assess factors associated with PTR and all-cause mortality. Results The cohort included 4076 patients; 2520 (61.8%) underwent PTR. Patients more likely to undergo PTR were younger and diagnosed earlier, underwent treatment at a nonacademic facility, lived on the West Coast or in the Central USA, and presented with smaller lower-grade small bowel primary tumors. Median OS was improved for patients who underwent PTR compared with those who did not (71 vs. 29 months, p  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-020-08602-7