Adjuvant therapy following resection of gastroenteropancreatic neuroendocrine tumors provides no recurrence or survival benefit.

Autor: Barrett JR; Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin., Rendell V; Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin., Pokrzywa C; Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin., Lopez-Aguiar AG; Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia., Cannon J; Department of Surgery, Stanford University, Stanford, California., Poultsides GA; Department of Surgery, Stanford University, Stanford, California., Rocha F; Department of Surgery, Virginia Mason Medical Center, Seattle, Washington., Crown A; Department of Surgery, Virginia Mason Medical Center, Seattle, Washington., Beal E; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio., Michael Pawlik T; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio., Fields R; Department of Surgery, Washington University in St. Louis, St. Louis, Missouri., Panni RZ; Department of Surgery, Washington University in St. Louis, St. Louis, Missouri., Smith P; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Idrees K; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Cho C; Department of Surgery, University of Michigan, Ann Arbor, Michigan., Beems M; Department of Surgery, University of Michigan, Ann Arbor, Michigan., Maithel S; Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia., Weber S; Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin., Erik Abbott D; Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2020 Jun; Vol. 121 (7), pp. 1067-1073. Date of Electronic Publication: 2020 Mar 09.
DOI: 10.1002/jso.25896
Abstrakt: Background and Objectives: Lack of high-level evidence supporting adjuvant therapy for patients with resected gastroenteropancreatic neuroendocrine tumors (GEP NETs) warrants an evaluation of its non-standard of care use.
Methods: Patients with primary GEP NETs who underwent curative-intent resection at eight institutions between 2000 and 2016 were identified; 91 patients received adjuvant therapy. Recurrence-free survival (RFS) and overall survival (OS) were compared between adjuvant cytotoxic chemotherapy and somatostatin analog cohorts.
Results: In resected patients, 33 received cytotoxic chemotherapy, and 58 received somatostatin analogs. Five-year RFS/OS was 49% and 83%, respectively. Cytotoxic chemotherapy RFS/OS was 36% and 61%, respectively, lower than the no therapy cohort (P < .01). RFS with somatostatin analog therapy (compared to none) was lower (P < .01), as was OS (P = .01). On multivariable analysis, adjuvant cytotoxic therapy was negatively associated with RFS but not OS controlling for patient/tumor-specific characteristics (RFS P < .01).
Conclusions: Our data, reflecting the largest reported experience to date, demonstrate that adjuvant therapy for resected GEP NETs is negatively associated with RFS and confers no OS benefit. Selection bias enriching our treatment cohort for individuals with unmeasured high-risk characteristics likely explains some of these results; future studies should focus on patient subsets who may benefit from adjuvant therapy.
(© 2020 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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