Nomogram predicting the risk of recurrence after curative-intent resection of primary non-metastatic gastrointestinal neuroendocrine tumors: An analysis of the US Neuroendocrine Tumor Study Group

• Type of Material: Article
• Authors: Katiuscha Merath, Ohio State University; Fabio Bagante, Ohio State University; Eliza W. Beal, Ohio State University; Alexandra G. Lopez-Aguiar, Emory University; George Poultsides, Stanford University; Eleftherios Makris, Stanford University; Flavio Rocha, Virginia Mason Medical Center; Zaheer Kanji, Virginia Mason Medical Center; Sharon Weber, University of Wisconsin; Alexander Fisher, University of Wisconsin; Ryan Fields, Washington University; Bradley A. Krasnick, Washington University; Kamran Idrees, Vanderbilt University; Paula M. Smith, Vanderbilt University; Cliff Cho, University of Michigan; Megan Beems, University of Michigan; Carl R. Schmidt, Ohio State University; Mary Dillhoff, Ohio State University; Shishir Maithel, Emory University; Timothy M. Pawlik, Ohio State University
• Language: English
• Date: 2018-04-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/jso.24985
• Title of Journal or Parent Work: Journal of Surgical Oncology
• ISSN: 0022-4790
• Volume: 117
• Issue: 5
• Start Page: 868
• End Page: 878
• Keywords: ENDOCRINE TUMORS; nomogram; Surgery; neuroendocrine tumors; Oncology; PROGNOSTIC-FACTORS; SINGLE INSTITUTION; Life Sciences & Biomedicine; CONSENSUS-GUIDELINES; NEOPLASMS; MANAGEMENT; LIVER METASTASES; RELAPSE-FREE SURVIVAL; Science & Technology; GRADING SYSTEM; LYMPH-NODE METASTASIS; recurrence
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Background: The risk of recurrence after resection of non-metastatic gastro-entero-pancreatic neuroendocrine tumors (GEP-NET) is poorly defined. We developed/validated a nomogram to predict risk of recurrence after curative-intent resection. Methods: A training set to develop the nomogram and test set for validation were identified. The predictive ability of the nomogram was assessed using c-indices. Results: Among 1477 patients, 673 (46%) were included in the training set and 804 (54%) in y the test set. On multivariable analysis, Ki-67, tumor size, nodal status, and invasion of adjacent organs were independent predictors of DFS. The risk of death increased by 8% for each percentage increase in the Ki-67 index (HR 1.08, 95% CI, 1.05-1.10; P < 0.001). GEP-NET invading adjacent organs had a HR of 1.65 (95% CI, 1.03-2.65; P = 0.038), similar to tumors ≥3 cm (HR 1.67, 95% CI, 1.11-2.51; P = 0.014). Patients with 1-3 positive nodes and patients with >3 positive nodes had a HR of 1.81 (95% CI, 1.12-2.87; P = 0.014) and 2.51 (95% CI, 1.50-4.24; P < 0.001), respectively. The nomogram demonstrated good ability to predict risk of recurrence (c-index: training set, 0.739; test set, 0.718). Conclusion: The nomogram was able to predict the risk of recurrence and can be easily applied in the clinical setting.