Loading...
Prognostic factors for relapse in resected gastroenteropancreatic neuroendocrine neoplasms: A systematic review and meta-analysis
Broadbent, Rachel Wheatley, Roseanna Stajer, S. Jacobs, Timothy Lamarca, Angela Amir, E McNamara, Mairead G
Broadbent, Rachel
Wheatley, Roseanna
Stajer, S.
Jacobs, Timothy
Lamarca, Angela
Amir, E
McNamara, Mairead G
Citations
Altmetric:
Abstract
Background: Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are a
rare, heterogeneous group of malignancies. Potential cure can be achieved through
surgical resection, but only 42-57% achieve 5-year disease-free survival. Here, the
factors associated with relapse following potentially-curative resection of GEP-NENs
are investigated, using a systematic review and meta-analysis.
Methods: A systematic search of MEDLINE, EMBASE, Web of Science, BIOSIS, CENTRAL, Cochrane Library, and abstracts from ESMO and ASCO was performed and last
updated July 2020. Prospective and retrospective studies reporting factors associated
with relapse in patients with GEP-NENs following resection of a primary tumour,
including concurrent resection of a metastatic site were included. Papers not
reporting the proportion of patients with tumour grades 1-3 were excluded. Only
variables which were reported by at least 3 studies were included in the meta-analysis. Hazard Ratios (HR) for Relapse-Free Survival (RFS) or Overall Survival (OS)
were weighted using generic inverse variance and pooled using random effects
modelling.
Results: Of 729 studies identified initially; 96 were eligible for inclusion in the meta-analysis (17,698 patients); 83 studies (14,801 patients) included pancreatic NENs only,
the remaining 13 studies reported on mixed primary site or non-pancreatic NENs. For
the entire cohort, on multivariable analysis, vascular resection performed [HR 2.25
(95% confidence interval (CI) 1.29-3.90), p¼0.004], M1 disease [HR 2.53 (95%CI 1.22-
5.23), p¼0.01], tumour size >20mm [HR 2.39 (95%CI 1.68-3.40), p 5% [HR 3.78 (95%
CI 2.12-6.76), p 20mm [HR 5.32 (95%CI 1.64-17.25), p¼0.005], grade 2 [HR 4.48 (95%
CI 2.89-6.94), p < 0.001], R1 resection [HR 2.97 (95%CI 1.47-6.02), p¼0.002],
microvascular invasion [HR 2.60 (95%CI 1.01-6.75), p¼0.049], perineural invasion [HR
2.48 (95%CI 1.17-5.25), p¼0.02] and any lymph node positivity [HR 3.67 (95%CI 2.44-
5.52), p < 0.001]. When studies reporting on mixed primary site or non-pancreatic
NENs were analysed independently, lymph node positivity [HR 2.21 (95%CI 1.58-3.08),
p < 0.001], grade 2 [HR 5.80 (95% CI 3.35-10.04), p < 0.001] lymphovascular invasion
[HR 4.90 (95% CI 1.39-17.26), p¼0.01], R1 resection [HR 2.40 (95% CI 1.36-4.22),
p¼0.002] were prognostic for worse RFS in the univariable analysis. For these studies,
pooling of multivariable data was possible only for lymph node positivity [HR 3.54
(95% CI 1.07-11.77), p¼0.04]. Few OS data were available for pooling; in univariable
analysis (entire cohort), grade 2 disease [HR 5.17 (95%CI 1.58-16.93), p¼0.007] was
prognostic for worse OS, while R1 resection was not [HR 1.89 (95%CI 0.82-4.39),
p¼0.14).
Conclusions: This is one of the largest meta-analyses to identify pathological tumour
characteristics which are prognostic for RFS and OS following resection of GEP-NENs.
The majority of included studies reported on pancreatic NENs, which may introduce
bias; however, the results will inform selection and stratification criteria for future
adjuvant trials.
Description
Date
2021
Publisher
Collections
Files
Loading...
From UNPAYWALL
Adobe PDF, 79.78 KB
Keywords
Type
Meetings and Proceedings
Citation
Broadbent R, Wheatley R, Stajer S, Jacobs T, Lamarca A, Hubner R, et al. P-53 Prognostic factors for relapse in resected gastroenteropancreatic neuroendocrine neoplasms: A systematic review and meta-analysis. Annals of Oncology. 2021 Jul;32:S114.