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Primary Tumor Resection is Associated with Improved Disease-Specific Mortality in Patients with Stage IV Small Intestinal Neuroendocrine Tumors (NETs): A Comparison of Upfront Surgical Resection Versus a Watch and Wait Strategy in Two Specialist NET Centers.
Levy, Sonja; Arthur, James D; Banks, Melissa; Kok, Niels F M; Fenwick, Stephen W; Diaz-Nieto, Rafael; van Leerdam, Monique E; Cuthbertson, Daniel J; Valk, Gerlof D; Kuhlmann, Koert F D; Tesselaar, Margot E T.
Affiliation
  • Levy S; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands. so.levy@nki.nl.
  • Arthur JD; Department of Surgery, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
  • Banks M; Department of Surgery, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
  • Kok NFM; Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
  • Fenwick SW; Department of Surgery, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
  • Diaz-Nieto R; Department of Surgery, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
  • van Leerdam ME; Department of Gastroenterologic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
  • Cuthbertson DJ; Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK.
  • Valk GD; Department of Endocrinology, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
  • Kuhlmann KFD; Department of Endocrine Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands.
  • Tesselaar MET; Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Ann Surg Oncol ; 29(12): 7822-7832, 2022 Nov.
Article in En | MEDLINE | ID: mdl-35842528
INTRODUCTION: Small intestinal neuroendocrine tumors (SI-NETs) often present with metastatic disease. An ongoing debate exists on whether to perform primary tumor resection (PTR) in patients with stage IV SI-NETs, without symptoms of the primary tumor and inoperable metastatic disease. OBJECTIVE: The aim of this study was to compare a treatment strategy of upfront surgical resection versus a surveillance strategy of watch and wait. METHODS: This was a retrospective cohort study of patients with stage IV SI-NETs at diagnosis, between 2000 and 2018, from two tertiary referral centers (Netherlands Cancer Institute [NKI] and Aintree University Hospital [AUH]) who had adopted contrasting treatment approaches: upfront surgical resection and watch and wait, respectively. Patients without symptoms related to the primary tumor were included. Multivariable intention-to-treat (ITT), per-protocol (PP), and instrumental variable (IV) analyses using 'institute' as an IV were performed to assess the influence of PTR on disease-specific mortality (DSM). RESULTS: A total of 557 patients were identified, with 145 patients remaining after exclusion of stage I-III disease or symptoms of the primary tumor (93 from the NKI and 52 from AUH). The cohorts differed in performance status (PS; p = 0.006) and tumor grade (p < 0.001). PTR was independently associated with reduced DSM irrespective of statistical methods employed: ITT hazard ratio [HR] 0.60, p = 0.005; PP HR 0.58, p < 0.001; and IV HR 0.07, p = 0.019. Other factors associated with DSM were age, PS, high chromogranin A, and somatostatin analog treatment. CONCLUSION: Taking advantage of contrasting institutional treatment strategies, this study identified PTR as an independent predictor of DSM. Future prospective studies should aim to validate these results.
Subject(s)

Full text: 1 Database: MEDLINE Main subject: Neuroendocrine Tumors / Intestinal Neoplasms Type of study: Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Year: 2022 Type: Article

Full text: 1 Database: MEDLINE Main subject: Neuroendocrine Tumors / Intestinal Neoplasms Type of study: Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Year: 2022 Type: Article