Management Strategies and Outcomes for Type 1 Gastric Neuroendocrine Tumors Measuring More Than 1 cm.
Elisabetta Dell’Unto, Rajaventhan Srirajaskanthan, Christos Toumpanakis, Louis de Mestier, Dermot O'Toole, Davide Campana, D Mark Pritchard, Marco Marini, Gianluca Esposito, Maria Rinzivillo, Dalvinder Mandair, Aman Saini, Klaire Exarchou, Giuseppe Lamberti, Grégoire Salin, Barra Neary, Alberto Murino, Edward John Despott, Bruno Annibale, Martyn Caplin, Francesco PanzutoObjectives.
Type 1 gastric neuroendocrine tumors (T1g-NETs) are well-differentiated lesions with excellent survival but frequent recurrence. Tumor size is the main prognostic factor, yet optimal management for tumors >1cm remains uncertain. This study aimed to evaluate treatment strategies and outcomes in patients with T1g-NETs>1 cm.
Methods.
We conducted a retrospective multicenter study including 106 adults with T1g-NETs>1 cm. Clinicopathologic and management data were collected. The primary outcome event was a composite unfavorable outcome (UO), defined as recurrence or progression, used to analyze progression-free survival as the main time-to-event outcome. Analyses included multinomial logistic regression, Cox models, and Kaplan–Meier curves (p<0.05).
Results.
Among 106 patients (58.5% female; median age 59), median tumor size was 15mm. Most tumors were Grade 1 (61.4%) or Grade 2 (37.7%), with median Ki-67 of 2%. Endoscopic resection was performed in 76 patients (71.7%), surgery in 33 (31.1%, including 13 initially treated endoscopically), and 10 (9.4%) were surveilled. Over a median 61-month follow-up, 24 patients (22.6%) recurred, 8 (7.5%) progressed; only 2 deaths (1.9%) were tumor-related. Larger tumors were associated with UO (p=0.005), with lesions ≥24mm predicting shorter progression-free survival (HR 3.93;p<0.001). Endoscopic submucosal dissection (ESD) and modified-endoscopic mucosal resection (m-EMR) were associated with a significantly longer progression-free survival (p=0.004). R0 resection showed a borderline protective effect. Five-year overall survival approached 95%.
Conclusions.
T1g-NETs>1cm frequently recur and may exhibit aggressive potential, particularly when lesions are larger. When endoscopic resection is feasible, ESD or m-EMR should be preferred to optimize outcomes.