Clinical features and outcomes of gastric neuroendocrine tumors after endoscopic diagnosis and treatment a digestive endoscopy society of tawian (dest)

Gastric neuroendocrine tumors (GNETs) are a heterogeneous group of neoplasm with varying biological characteristics. This study aimed to investigate the clinical features and outcomes of GNET patients after endoscopic diagnosis and treatment in a multicenter registry. Patients with GNETs confirmed histologically were recruited from 17 hospitals between January 2010 and April 2016 in Taiwan. Clinical, laboratory, radiological, endoscopic, pathological data, treatment strategies, follow-up periods, and survivals were collected retrospectively. Totally 187 (107 female, 80 male) patients were recruited. Mean (±standard deviation [SD]) age and size of tumors were 63.2-year-old (±14.6) and 2.3-cm (±3.0). World Health Organization (WHO) grading were 93 (49.7%) G1, 26 (13.9%) G2, 40 (21.4%) G3, and 28 (15.0%) unknown. G3 patients were older (mean±SD, 71.6±12.4 vs. 60.9±14.3/56.7±15.4 years), larger (6.1±4.0 vs.1.2±1.3/2.4±2.5 cm), more distally located (35.0% vs. 7.6%/15.4%), lower proportion of superficial lesions (17.5% vs. 61.9%/53.8%) and higher rates of lymphovascular invasion (32.5% vs. 3.2%/7.7%) than G1/G2. There was no nodal or distant organ metastases despite different grading of lesions≦10mm and those <20mm limited to mucosa and submucosa layers. GNETs larger than 20mm with G1, G2, and G3 had lymph node (LN) metastatic rates of 21.4%, 30.0%, and 59.3%, respectively. Survivals were different between grading for those >20mm(log-rank test P=.02). Male gender (P=.01), deeper invasion (P=.0001), nodal (P<.0001), and distant organ metastases (P=.0001) were associated with worse outcome. In conclusion, treatment strategies for GNET should be decided by grading, size, invasiveness, and LN metastasis risk. Curative endoscopic resection is feasible for G1/2 lesions less than 20mm and limited to mucosa/submucosa layers without lymphovascular invasion.