Merola Elettra, Falconi Massimo, Rinke Anja, Staettner Stefan, Krendl Felix, Partelli Stefano, Andreasi Valentina, Gress Thomas M, Pascher Andreas, Arsenic Ruza, Doglioni Claudio, Kaemmerer Daniel, Wiedenmann Bertram, Pavel Marianne E
Department of Medicine 1, Division of Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Department of Gastroenterology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital IRCCS, Milan, Italy.
Am J Surg. 2020 Aug;220(2):284-289. doi: 10.1016/j.amjsurg.2020.03.009. Epub 2020 Mar 14.
Stage IV gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs) G3 are the NENs with the worst prognosis. According to ENETS guidelines, platinum-based chemotherapy is the standard treatment for this population. Surgery is only considered in highly selected "resectable" NENs with usually lower Ki67. However, the role of surgery with curative intent has been poorly investigated.
To describe, in a retrospective series of stage IV GEP-NENs G3, overall survival (OS) and recurrence-free survival (RFS) rates after curatively intended surgery.
Multicenter analysis of stage IV GEP-NENs G3 receiving radical resection (R0/R1) from 2007 to 2017, with minimum post-surgical follow-up time of 3 months.
Fifteen patients from 6 NEN referral centers, with median follow-up of 29 months (8-86), were included. Eight cases had a neuroendocrine carcinoma (NEC) and 7 a neuroendocrine tumor G3 (NET G3). Median OS after radical surgery was 59 months. All patients recurred, with a median RFS of 8 months.
Radical surgery might be considered for highly selected stage IV GEP-NENs G3. Larger series are needed to confirm these results.
IV期胃肠胰神经内分泌肿瘤（GEP-NENs）G3是预后最差的神经内分泌肿瘤。根据欧洲神经内分泌肿瘤学会（ENETS）指南，铂类化疗是该人群的标准治疗方法。手术仅考虑用于高度选择的、通常Ki67较低的“可切除”神经内分泌肿瘤。然而，具有治愈意图的手术的作用尚未得到充分研究。
在一组回顾性IV期GEP-NENs G3病例中，描述具有治愈意图的手术后的总生存期（OS）和无复发生存期（RFS）率。
对2007年至2017年接受根治性切除（R0/R1）的IV期GEP-NENs G3进行多中心分析，术后最短随访时间为3个月。
纳入了来自6个神经内分泌肿瘤转诊中心的15例患者，中位随访时间为29个月（8 - 86个月）。8例为神经内分泌癌（NEC），7例为神经内分泌肿瘤G3（NET G3）。根治性手术后的中位OS为59个月。所有患者均复发，中位RFS为8个月。
对于高度选择的IV期GEP-NENs G3患者，可考虑行根治性手术。需要更大规模的系列研究来证实这些结果。
