Yıl: 2020 Cilt: 31 Sayı: 2 Sayfa Aralığı: 91 - 98 Metin Dili: İngilizce DOI: 10.5152/tjg.2020.18919 İndeks Tarihi: 09-06-2021

Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience

Öz:
Background/Aims: Gastric neuroendocrine tumors (G-NETs) are rare tumors, but their incidence is gradually increasing. Despite the existence of many classification systems, determining prognosis and planning treatment in patients with G-NETs remains a clinical challenge. In this study, the prognostic value of the World Health Organization (WHO) 2017 grading system and the effect of surgery on survival in low grade neuroendocrine tumors were investigated. Materials and Methods: G-NETs who were diagnosed between January 2000 and May 2017 were included in the study. Patients’ demographic characteristics, treatment details, and survival data were obtained from medical charts. Pathological samples were re-classified according to the WHO 2017 grading system. Results: Of the total 94 evaluated patients, 50 (53.2%) were classified with G1 NETs, 37(39.4%) with G2 NETs, 4(4.2%) with well-differentiated G3 NETs, and the remaining 3 patients with poorly differentiated G3 neuroendocrine carcinoma (NEC). The median follow-up time was 83.2 months. There was a statistically significant difference in 5-year progression free survival (PFS) between G1 tumors (100%) and G2 tumors (76%) (p<0.001). However, there was no statistically significant deference in 5-year overall survival rate (OS) for G1 (97%) and G2 (82%) tumors (p=0.141). When G2 and G1 NETs were compared according to their surgical approach, radical surgery was more frequently performed in patients with G2 tumors (p<0.001). However, radical surgery did not improve PFS in G1 and G2 NETs. Conclusion: The WHO 2017 NET classification system may have low prognostic value for determining the prognosis of patients with G1 and G2 tumors. Radical surgery for G1 and G2 NETs did not improve PFS in our study.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Öberg K, Åkerström G, Rindi G, Jelic S; ESMO Guidelines Working Group. Neuroendocrine gastroenteropancreatic tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21: v223-v7.
  • 2. Modlin IM, Moss SF, Chung DC, Jensen RT, Snyderwine E. Priorities for improving the management of gastroenteropancreatic neuro endocrine tumors. J Natl Cancer Inst 2008; 100: 1282-9.
  • 3. Shen C, Chen H, Chen H, et al. Surgical treatment and prognosis of gastric neuroendocrine neoplasms: a single-center experience. BMC Gastroenterol 2016; 16: 111.
  • 4. Liu DJ, Fu XL, Liu W, et al. Clinicopathological, treatment, and prognosis study of 43 gastric neuroendocrine carcinomas. World J Gastroenterol 2017; 23: 516-24.
  • 5. La Rosa S, Inzani F, Vanoli A, et al. Histologic characterization and improved prognostic evaluation of 209 gastric neuroendocrine neo plasms. Hum Pathol 2011; 42: 1373-84.
  • 6. La Rosa S, Vanoli A. Gastric neuroendocrine neoplasms and re lated precursor lesions. J Clin Pathol 2014; 67: 938-48.
  • 7. Yang Z, Wang W, Lu J, et al. Gastric Neuroendocrine Tumors (G-Nets): Incidence, Prognosis and Recent Trend Toward Improved Survival. Cell Physiol Biochem 2018; 45: 389-96.
  • 8. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003; 97: 934-59.
  • 9. Chen WF, Zhou PH, Li QL, Xu MD, Yao LQ. Clinical impact of endo scopic submucosal dissection for gastric neuroendocrine tumors: a retrospective study from mainland of China. ScientificWorldJournal 2012; 2012: 869769.
  • 10. Dobru D, Boeriu A, Mocan S, Pascarenco O, Boeriu C, Molnar C. Gastric carcinoids and terapeutic options. Case report and review of the literature. J Gastrointestin Liver Dis 2013; 22: 93-6.
  • 11. Delle Fave G, Sundin A, Taal B, et al. ENETS consensus guidelines update for gastroduodenal neuroendocrine neoplasms. Neuroendo crinology 2016; 103: 119-24.
  • 12. de Mestier L, Cros J, Neuzillet C, et al. Digestive System Mixed Neuroendocrine-Non-Neuroendocrine Neoplasms. Neuroendocri nology 2017; 105: 412-25.
  • 13. Rindi G, Arnold R, Bosman FT, et al. Nomenclature and classifica tion of neuroendocrine neoplasms of the digestive system. In: WHO Classification Tumours of the Digestive System, 4th ed, Bosman TF, Carneiro F, Hruban RH, Theise ND (Eds), International Agency for Re seach on Cancer (IARC), Lyon 2010. p.13-4.
  • 14. Kim JY, Hong SM, Ro JY. Recent updates on grading and clas sification of neuroendocrine tumors. Annals Diagn Pathol 2017; 29: 11-6.
  • 15. Rindi G, Wiedenmann B. Neuroendocrine neoplasms of the gut and pancreas: new insights. Nat Rev Endocrinol 2012; 8: 54-64.
  • 16. Ahlman H, Wängberg B, Jansson S, et al. Interventional treatment of gastrointestinal neuroendocrine tumours. Digestion 2000; 62: 59- 68.
  • 17. Basuroy R, Srirajaskanthan R, Prachalias A, Quaglia A, Ramage J. the investigation and management of gastric neuroendocrine tu mours. Aliment Pharmacol Ther 2014; 39: 1071-84.
  • 18. Higham AD, Dimaline R, Varro A, et al. Octreotide suppression test predicts beneficial outcome from antrectomy in a patient with gastric carcinoid tumor. Gastroenterology 1998; 114: 817-22.
  • 19. Richards ML, Gauger P, Thompson NW, Giordano TJ. Regression of type II gastric carcinoids in multiple endocrine neoplasia type 1 patients with Zollinger-Ellison syndrome after surgical excision of all gastrinomas. World J Surg 2004; 28: 652-8.
  • 20. Kouraklis G, Misiakos E, Glinavou A, Raftopoulos J, Karatzas G. Man agement of enterochromaffin-like gastric carcinoid tumour metasta sized to the liver. Scand J Gastroenterol 2002; 37: 246-8.
  • 21. Huang PY, Tsai KL, Liang CM, et al. Prognostic factors of patients with gastroenteropancreatic neuroendocrine neoplasms. Kaohsiung J Med Sci 2018; 34: 650-6.
  • 22. Schreckenbach T, Hübert H, Koch C, et al. Surgical resection of neuroendocrine tumor liver metastases as part of multimodal treat ment strategies: A propensity score matching analysis. Eur J Surg Oncol 2018; 45: 808-15.
  • 23. Kim BS, Park YS, Yook JH, Oh ST, Kim BS. Differing clinical cours es and prognoses in patients with gastric neuroendocrine tumors based on the 2010-WHO classification scheme. Medicine (Balti more) 2015; 94; e1748.
  • 24. Kim BS, Park YS, Yook JH, Kim BS. Comparison of the prognostic values of the 2010 WHO classification, AJCC 7th edition, and ENETS classification of gastric neuroendocrine tumors. Medicine (Balti more) 2016; 95: e3977.
  • 25. Nandy N, Hanson JA, Strickland RG, McCarthy DM. Solitary gas tric carcinoid tumor associated with long-term use of omeprazole: a case report and review of the literature. Dig Dis Sci 2016; 61: 708-12.
  • 26. Li TT, Qiu F, Qian ZR, Wan J, Qi XK, Wu BY. Classification, clini copathologic features and treatment of gastric neuroendocrine tu mors. World J Gastroenterol 2014; 20: 118-25.
  • 27. Bar-Moshe Y, Mazeh H, Grozinsky-Glasberg S. Non-functioning pancreatic neuroendocrine tumors: Surgery or observation? World J Gastrointest Endosc 2017; 9: 153-61.
  • 28. Song SH, Shin JH, Ryu HJ, Kim DJ, Park SY. Successful Surgical Treatment of a Recurrent Esophageal Malignant Gastrointestinal Neuroectodermal Tumor. Korean J Thorac Cardiovasc Surg 2018; 51: 142-5.
  • 29. Ilett EE, Langer SW, Olsen IH, Federspiel B, Kjær A, Knigge U. Neuroendocrine carcinomas of the gastroenteropancreatic system: a comprehensive review. Diagnostics 2015; 5: 119-76.
  • 30. Hijioka S, Hosoda W, Mizuno N, et al. Does the WHO 2010 clas sification of pancreatic neuroendocrine neoplasms accurately characterize pancreatic neuroendocrine carcinomas? J Gastroenterol 2015; 50: 564-72.
  • 31. Basturk O, Tang L, Hruban RH, et al. Poorly differentiated neuro endocrine carcinomas of the pancreas: a clinicopathologic analysis of 44 cases. Am J Surg Pathol 2014; 38: 437-47.
  • 32. Basturk O, Yang Z, Tang LH, et al. The high grade (WHO G3) pancre atic neuroendocrine tumor category is morphologically and biologically heterogeneous and includes both well differentiated and poorly differ entiated neoplasms. Am J Surg Pathol 2015; 39: 683-90
  • 33. Liu SZ, Zhang F, Chang YX, et al. Prognostic impact of cyclin D1, cyclin E and P53 on gastroenteropancreatic neuroendocrine tu mours. Asian Pac J Cancer Prev 2013; 14: 419-22.
  • 34. Tomassetti P, Migliori M, Caletti GC, Fusaroli P, Corinaldesi R, Gullo L. Treatment of type II gastric carcinoid tumors with soma tostatin analogues. N Engl J Med 2000; 343: 551-4.
  • 35. Caplin M, Hodgson H, Dhillon A, et al. Multimodality treatment for gastric carcinoid tumor with liver metastases. Am J Gastroenterol 1998; 93: 1945-8.
  • 36. Schillaci O, Spanu A, Scopinaro F, et al. Somatostatin receptor scintigraphy with 111In-pentetreotide in non-functioning gastroen teropancreatic neuroendocrine tumors. Int J Oncol 2003; 23: 1687- 95.
  • 37. Lebtahi R, Cadiot G, Sarda L, et al. Clinical impact of somatosta tin receptor scintigraphy in the management of patients with neu roendocrine gastroenteropancreatic tumors. J Nucl Med 1997; 38: 853-8.
  • 38. Rinke A, Wittenberg M, Schade-Brittinger C, et al. Placebo-con trolled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with met astatic neuroendocrine midgut tumors (PROMID): results of long term survival. Neuroendocrinology 2017; 104: 26-32.
APA karakas y, Lacin S, Kurtulan O, esin e, Sunar V, SOKMENSUER C, Kılıçkap S, yalcin s (2020). Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience. , 91 - 98. 10.5152/tjg.2020.18919
Chicago karakas yusuf,Lacin Sahin,Kurtulan Olcay,esin ece,Sunar Veli,SOKMENSUER CENK,Kılıçkap Saadettin,yalcin suayib Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience. (2020): 91 - 98. 10.5152/tjg.2020.18919
MLA karakas yusuf,Lacin Sahin,Kurtulan Olcay,esin ece,Sunar Veli,SOKMENSUER CENK,Kılıçkap Saadettin,yalcin suayib Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience. , 2020, ss.91 - 98. 10.5152/tjg.2020.18919
AMA karakas y,Lacin S,Kurtulan O,esin e,Sunar V,SOKMENSUER C,Kılıçkap S,yalcin s Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience. . 2020; 91 - 98. 10.5152/tjg.2020.18919
Vancouver karakas y,Lacin S,Kurtulan O,esin e,Sunar V,SOKMENSUER C,Kılıçkap S,yalcin s Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience. . 2020; 91 - 98. 10.5152/tjg.2020.18919
IEEE karakas y,Lacin S,Kurtulan O,esin e,Sunar V,SOKMENSUER C,Kılıçkap S,yalcin s "Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience." , ss.91 - 98, 2020. 10.5152/tjg.2020.18919
ISNAD karakas, yusuf vd. "Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience". (2020), 91-98. https://doi.org/10.5152/tjg.2020.18919
APA karakas y, Lacin S, Kurtulan O, esin e, Sunar V, SOKMENSUER C, Kılıçkap S, yalcin s (2020). Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience. Turkish Journal of Gastroenterology, 31(2), 91 - 98. 10.5152/tjg.2020.18919
Chicago karakas yusuf,Lacin Sahin,Kurtulan Olcay,esin ece,Sunar Veli,SOKMENSUER CENK,Kılıçkap Saadettin,yalcin suayib Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience. Turkish Journal of Gastroenterology 31, no.2 (2020): 91 - 98. 10.5152/tjg.2020.18919
MLA karakas yusuf,Lacin Sahin,Kurtulan Olcay,esin ece,Sunar Veli,SOKMENSUER CENK,Kılıçkap Saadettin,yalcin suayib Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience. Turkish Journal of Gastroenterology, vol.31, no.2, 2020, ss.91 - 98. 10.5152/tjg.2020.18919
AMA karakas y,Lacin S,Kurtulan O,esin e,Sunar V,SOKMENSUER C,Kılıçkap S,yalcin s Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience. Turkish Journal of Gastroenterology. 2020; 31(2): 91 - 98. 10.5152/tjg.2020.18919
Vancouver karakas y,Lacin S,Kurtulan O,esin e,Sunar V,SOKMENSUER C,Kılıçkap S,yalcin s Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience. Turkish Journal of Gastroenterology. 2020; 31(2): 91 - 98. 10.5152/tjg.2020.18919
IEEE karakas y,Lacin S,Kurtulan O,esin e,Sunar V,SOKMENSUER C,Kılıçkap S,yalcin s "Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience." Turkish Journal of Gastroenterology, 31, ss.91 - 98, 2020. 10.5152/tjg.2020.18919
ISNAD karakas, yusuf vd. "Prognostic value of the 2017 World Health Organization Classification System for gastric neuroendocrine tumors: A single-center experience". Turkish Journal of Gastroenterology 31/2 (2020), 91-98. https://doi.org/10.5152/tjg.2020.18919