ANKMJ
Ankyra Medical Journal

Ankyra Medical Journal (AnkMJ), formerly known as the Journal of Translational and Practical Medicine, regularly publishes international quality issues in the field of Medicine in the light of current information.

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Original Article
The impact of surgical resection on prognosis in gastric neuroendocrine tumors
Abstract
Aims: This study aimed to investigate the pathological factors influencing prognosis in patients undergoing surgical resection for GNETs, in the context of the World Health Organization 2010 staging system.
Methods: This retrospective study included 27 patients who underwent surgical resection for GNETs diagnosis between 2001 and 2015. Patients were clinically categorized into four types based on gastric NET characteristics: type 1 tumors, which are typified by hypergastrinemia and develop on a background of atrophic gastritis; type 2 tumors, which are related with gastrinomas; type 3 tumors, which have low serum gastrin levels and no underlying mucosal pathology, and type 4, which are characterized by neuroendocrine carcinoma. Additionally, all patients were classified according to the TNM staging system.
Results: The median age of the patients was 56 years (range: 33-81), and most patients were identified as type I (55.6%), with subsequent groups being type IV (25.9%) and type III (18.5%). The majority of type I patients were classified as stage I, while the majority of type III patients were in stage IIA, and most type IV patients were in stage IIIB. Type III and type IV groups exhibited a higher rate of lymph node metastasis compared to type I group (Type I: 13.3% vs. Type II: 80.0% vs. Type IV: 57.1%, p < 0.001). The mortality rate was higher in the Type IV group compared to other groups (Type I: 0% vs. Type II: 20% vs. Type IV: 57.1%, p < 0.001). The Ki-67 levels were higher in patients with lymph node metastasis than in those without.
Conclusion: Type III and IV GNETs are at a higher risk of lymph node metastasis and mortality. The Ki-67 value assessed through preoperative endoscopic biopsy may serve as a guide for deciding on the necessity of lymph node dissection.

Keywords : Classification, Ki-67, neuroendocrine tumor, stomach, prognosis

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1. Dias AR, Azevedo BC, Alban LBV, et al. Gastric neuroendocrinetumor: review and update. Arq Bras Cir Dig. 2017;30(2):150-154.doi:10.1590/0102-6720201700020016
2. Yao JC, Hassan M, Phan A, et al. One hundred years after &ldquo;carcinoid&rdquo;:epidemiology of and prognostic factors for neuroendocrine tumors in35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063-3072.doi:10.1200/JCO.2007.15.4377
3. Dasari A, Shen C, Halperin D, et al. Trends in the incidence, prevalence,and survival outcomes in patients with neuroendocrine tumors inthe United States. JAMA Oncol. 2017;3(10):1335-1342. doi:10.1001/jamaoncol.2017.0589
4. Iwasaki K, Barroga E, Enomoto M, et al. Long-term surgical outcomesof gastric neuroendocrine carcinoma and mixed neuroendocrine-non-neuroendocrine neoplasms. World J Surg Oncol. 2022;20(1):165.doi:10.1186/s12957-022-02625-y
5. Benson AB, III, Broder MS, Cai B, Chang E, Neary MP, Papoyan E. Real-world treatment patterns of gastrointestinal neuroendocrine tumors: aclaims database analysis. World J Gastroenterol. 2017;23(33):6128-6136.doi:10.3748/wjg.v23.i33.6128
6. Rindi G. Nomenclature and classification of neuroendocrine neoplasms of thedigestive system. In: Bosman T, Carneiro F, Hruban RH, Theise ND, editors.WHO Classification of Tumours of the Digestive System. 4th ed. Lyon, France:International Agency for Research on Cancer (IARC). 2010:13-14.
7. Kloppel G, Rindi G, Perren A, Komminoth P, Klimstra DS. The ENETSand AJCC/UICC TNM classifications of the neuroendocrine tumors ofthe gastrointestinal tract and the pancreas: a statement. Virchows Arch.2010;456(6):595-597. doi:10.1007/s00428-010-0924-6
8. Cavalcanti MS, Gonen M, Klimstra DS. The ENETS/WHO gradingsystem for neuroendocrine neoplasms of the gastroenteropancreaticsystem: a review of the current state, limitations and proposals formodifications. Int J Endocr Oncol. 2016;3(3):203-219. doi:10.2217/ije-2016-0006
9. Capelli P, Fassan M, Scarpa A. Pathology-grading and staging ofGEP-NETs. Best Pract Res Clin Gastroenterol. 2012;26(6):705-717.doi:10.1016/j.bpg.2013.01.003
10. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification oftumours of the digestive system. 4 ed. Lyon: International Agency forResearch on Cancer (2010).
11. Ahmed M. Gastrointestinal neuroendocrine tumors in 2020. World JGastrointest Oncol. 2020;12(8):791-807. doi:10.4251/wjgo.v12.i8.791
12. Noh JH, Kim DH, Yoon H, et al. Clinical outcomes of endoscopictreatment for type 1 gastric neuroendocrine tumor. J Gastrointest Surg.2021;25(10):2495-2502. doi:10.1007/s11605-021-04997-0
13. Assis Filho AC, Tercioti Junior V, Andreollo NA, Ferrer JAP,Coelho Neto JS, Lopes LR. Gastric neuroendocrine tumor: whensurgical treatment is indicated? Arq Bras Cir Dig. 2023;36:e1768.doi:10.1590/0102-672020230050e1768
14. Modlin IM, Lye KD, Kidd M. A 50-year analysis of 562 gastriccarcinoids: small tumor or larger problem? Am J Gastroenterol.2004;99(1):23-32. doi:10.1046/j.1572-0241.2003.04027.x
15. Hirschowitz BI, Griffith J, Pellegrin D, Cummings OW. Rapidregression of enterochromaffinlike cell gastric carcinoids in perniciousanemia after antrectomy. Gastroenterology. 1992;102(4):1409-1418.
16. Wang J, Wang L, Li S, et al. Risk factors of lymph node metastasis andits prognostic significance in early gastric cancer: a multicenter study.Front Oncol. 2021;11:649035. doi:10.3389/fonc.2021.649035
17. Sato Y. Endoscopic diagnosis and management of type I neuroendocrinetumors. World J Gastrointest Endosc. 16 2015;7(4):346-353. doi:10.4253/wjge.v7.i4.346
18. Sandler M, Snow PJ. An atypical carcinoid tumour secreting5-hydroxytryptophan. Lancet. 1958;1(7012):137-139. doi:10.1016/s0140-6736(58)90616-0
19. Kargwal N, Panda V, Jha A, Singh CB. Gastric neuroendocrine tumor.Surg J (N Y). 2021;7(3):e142-e146. doi:10.1055/s-0041-1731427
20. Sorbye H, Grande E, Pavel M, et al. European Neuroendocrine TumorSociety (ENETS) 2023 guidance paper for digestive neuroendocrinecarcinoma. J Neuroendocrinol. 2023;35(3):e13249. doi:10.1111/jne.13249
21. Ye H, Yuan Y, Chen P, Zheng Q. Risk factors for metastasis andsurvival of patients with T1 gastric neuroendocrine carcinoma treatedwith endoscopic therapy versus surgical resection. Surg Endosc.2022;36(8):6162-6169. doi:10.1007/s00464-022-09190-1
22. Namikawa K, Kamada T, Fujisaki J, et al. Clinical characteristics andlong-term prognosis of type 1 gastric neuroendocrine tumors in a largeJapanese national cohort. Dig Endosc. 2023;35(6):757-766. doi:10.1111/den.14529
23. Kurtulan O, Turhan N, Gedikoglu G, Akyol A, Sokmensuer C. Definingprognostic parameters of well-differentiated gastric neuroendocrinetumors based on metastatic potential: a two-center experience. ActaGastro-Enterologica Belgica. 2022;85(2):339-345.
24. Chung CS, Tsai CL, Chu YY, et al. Clinical features and outcomesof gastric neuroendocrine tumors after endoscopic diagnosis andtreatment: a digestive endoscopy society of Tawian (DEST). Medicine.2018;97(38):e12101. doi:10.1097/MD.0000000000012101
25. Sato Y, Imamura H, Kaizaki Y, et al. Management and clinical outcomesof type I gastric carcinoid patients: retrospective, multicenter study inJapan Dig Endosc. 2014;26(3):377-384. doi:10.1111/den.12197
26. Yang MW, Fu XL, Jiang YS, et al. Clinical significance of programmeddeath 1/programmed death ligand 1 pathway in gastric neuroendocrinecarcinomas. World J Gastroenterol. 2019;25(14):1684-1696. doi:10.3748/wjg.v25.i14.1684
27. Cheng Y, Zhang X, Zhou X, Xu K, Lin M, Huang Q. Differences inclinicopathology and prognosis between gastroesophageal junctionaland gastric non-cardiac neuroendocrine carcinomas: a retrospectivecomparison study of consecutive 56 cases from a single institution inChina. Am J Cancer Res. 2022;12(10):4737-4750.
28. Li Z, Ren H, Wang T, et al. Resection of the primary tumor improvesthe survival of patients with stage iv gastric neuroendocrine carcinoma.Front Oncol. 2022;12:930491. doi:10.3389/fonc.2022.930491
29. Kim Y, Ahn B, Choi KD, et al. Gastric neuroendocrine tumorsaccording to the 2019 world health organization grading system:a single-center, retrospective study. Gut Liver. 2023;17(6):863-873.doi:10.5009/gnl220175
30. Sok C, Ajay PS, Tsagkalidis V, Kooby DA, Shah MM. Managementof gastric neuroendocrine tumors: a review. Ann Surg Oncol.2024;31(3):1509-1518. doi:10.1245/s10434-023-14712-9
31. Merola E, Sbrozzi-Vanni A, Panzuto F, et al. Type I gastric carcinoids:a prospective study on endoscopic management and recurrence rate.Neuroendocrinology. 2012;95(3):207-213. doi:10.1159/000329043
32. Uygun A, Kadayifci A, Polat Z, et al. Long-term results of endoscopicresection for type I gastric neuroendocrine tumors. J Surg Oncol.2014;109(2):71-74. doi:10.1002/jso.23477
33. Choi SM, Kim MC, Jung GJ, et al. Laparoscopic wedge resectionfor gastric GIST: long-term follow-up results. Eur J Surg Oncol.2007;33(4):444-447. doi:10.1016/j.ejso.2006.11.003
34. Kimiloglu Sahan E, Erdogan N, Ulusoy I, Samet E, Akyildiz IgdemA, Gonullu D. P53, KI-67, CD117 expression in gastrointestinaland pancreatic neuroendocrine tumours and evaluation of theircorrelation with clinicopathological and prognostic parameters. Turk JGastroenterol. 2015;26(2):104-111. doi:10.5152/tjg.2015.1965
35. Seo SH, Kim KH, Oh SH, et al. Ki-67 labeling index as a prognosticmarker in advanced stomach cancer. Ann Surg Treat Res. 2019;96(1):27-33. doi:10.4174/astr.2019.96.1.27
36. Ko GH, Go SI, Lee WS, et al. Prognostic impact of Ki-67 in patientswith gastric cancer-the importance of depth of invasion andhistologic differentiation. Medicine. 2017;96(25):e7181. doi:10.1097/MD.0000000000007181
Article available in :
Volume 3, Issue 2, 2024
Page : 49-53
https://doi.org/10.51271/ANKMJ-0010
Article Information
Received : 20 Şub 2024
Accepted : 24 Mar 2024
Published : 26 Mar 2024
Corresponding Author :

Halit Batuhan Demir: Department of General Surgery, Faculty of Medicine, Ege University, İzmir, Turkiye

[email protected]
Citation : Demir HB, Fırat Ö. The impact of surgical resection on prognosis in gastric neuroendocrine tumors. Ank Med J. 2024;3(2):49-53.

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