TY - JOUR
T1 - Clinical, pathological, and demographic factors associated with development of recurrences after surgical resection in elderly patients with neuroendocrine tumors
AU - Shen, C.
AU - Dasari, A.
AU - Chu, Y.
AU - Halperin, D. M.
AU - Zhou, S.
AU - Xu, Y.
AU - Shih, Y. T.
AU - Yao, J. C.
N1 - Funding Information:
This work was supported in part by Ipsen Pharma. The funder sponsored the purchase of SEER-Medicare data and provided funding for analytical support. All authors had unrestricted access to the final study data on request, were responsible for data interpretation, manuscript preparation, and the decision to submit for publication, and attest to the completeness and accuracy of the data and statistical analysis. No grant number is applicable. Unlabelled Box Key Message
Funding Information:
This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. This work was supported in part by Ipsen Pharma. The funder sponsored the purchase of SEER-Medicare data and provided funding for analytical support. All authors had unrestricted access to the final study data on request, were responsible for data interpretation, manuscript preparation, and the decision to submit for publication, and attest to the completeness and accuracy of the data and statistical analysis. No grant number is applicable., The authors have declared no conflicts of interest.
Publisher Copyright:
© 2017 European Society for Medical Oncology
PY - 2017/7
Y1 - 2017/7
N2 - Background: Incidence of locoregional neuroendocrine tumors (NETs) is rising. However, after curative resection, the patterns and risk factors associated with recurrence remain unknown. Consensus guidelines recommend surveillance every 6–12 months for up to 10 years after surgery for resected, well-differentiated NETs irrespective of patient demographics, site, grade or stage of tumor with few exceptions. Patients and methods: From the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified localized and regional stage NET patients who underwent surgical resection between January 2002 and December 2011. Development of recurrence was identified by capturing at least two claims indicative of metastatic disease until 31 December 2013. Results: Of the 2366 identified patients (median age 73 years), 369 (16%) developed metastatic disease within 5 years and only an additional 1% developed metastases between years 5 and 10 with the majority dying due to unrelated causes. The 5-year risk of developing metastases (hazard ratio, HR) varied significantly (log-rank P < 0.001) by grade: 9.9% versus 25.9% (2.2) versus 48.1% (4.4) for grades 1, 2, and ≥ 3, respectively; stage: 10.3% versus 31.1% (2.8) for localized versus regional; primary tumor size: 7.6% versus 15% (1.3) versus 26.6% (1.5) for <1, 1–2, and > 2 cm, respectively; and site: ranging from 11.3% for colon to 23.9% for pancreas. Conclusions: Contrary to current guidelines, our study suggests that surveillance recommendations should be tailored according to patient and tumor characteristics. Surveillance past 5 years may be avoided in elderly patients with competing morbidities or low risk of recurrence. Pancreatic, lung, higher grade, and regional NETs have a higher risk of recurrence and may be considered for future adjuvant trials.
AB - Background: Incidence of locoregional neuroendocrine tumors (NETs) is rising. However, after curative resection, the patterns and risk factors associated with recurrence remain unknown. Consensus guidelines recommend surveillance every 6–12 months for up to 10 years after surgery for resected, well-differentiated NETs irrespective of patient demographics, site, grade or stage of tumor with few exceptions. Patients and methods: From the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified localized and regional stage NET patients who underwent surgical resection between January 2002 and December 2011. Development of recurrence was identified by capturing at least two claims indicative of metastatic disease until 31 December 2013. Results: Of the 2366 identified patients (median age 73 years), 369 (16%) developed metastatic disease within 5 years and only an additional 1% developed metastases between years 5 and 10 with the majority dying due to unrelated causes. The 5-year risk of developing metastases (hazard ratio, HR) varied significantly (log-rank P < 0.001) by grade: 9.9% versus 25.9% (2.2) versus 48.1% (4.4) for grades 1, 2, and ≥ 3, respectively; stage: 10.3% versus 31.1% (2.8) for localized versus regional; primary tumor size: 7.6% versus 15% (1.3) versus 26.6% (1.5) for <1, 1–2, and > 2 cm, respectively; and site: ranging from 11.3% for colon to 23.9% for pancreas. Conclusions: Contrary to current guidelines, our study suggests that surveillance recommendations should be tailored according to patient and tumor characteristics. Surveillance past 5 years may be avoided in elderly patients with competing morbidities or low risk of recurrence. Pancreatic, lung, higher grade, and regional NETs have a higher risk of recurrence and may be considered for future adjuvant trials.
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U2 - 10.1093/annonc/mdx164
DO - 10.1093/annonc/mdx164
M3 - Article
C2 - 28444105
AN - SCOPUS:85041243155
SN - 0923-7534
VL - 28
SP - 1582
EP - 1589
JO - Annals of Oncology
JF - Annals of Oncology
IS - 7
ER -