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Gastric neuroendocrine neoplasms type 1: A systematic review and meta-analysis
Karolinska Inst, Dept Oncol & Pathol, Solna R8 04, S-17177 Stockholm, Sweden;Karolinska Univ Hosp, CCK, S-17176 Stockholm, Sweden.
Univ Athens, Dept Propauped Internal Med 1, Endocrine Oncol Unit, Laiko Hosp, Athens 11527, Greece.
Karolinska Univ Hosp, Dept Digest Dis, S-14186 Stockholm, Sweden.
Univ Athens, Dept Propauped Internal Med 1, Endocrine Oncol Unit, Laiko Hosp, Athens 11527, Greece.
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2019 (English)In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 25, no 35, p. 5376-5387Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND

To date, the histopathological parameters predicting the risk of lymph node (LN) metastases and local recurrence, associated mortality and appropriateness of endoscopic or surgical resection in patients with gastric neuroendocrine neoplasms type 1 (GNENs1) have not been fully elucidated.

AIM

To determine the rate of LN metastases and its impact in survival in patients with GNEN1 in relation to certain clinico-pathological parameters.

METHODS

The PubMed, EMBASE, Cochrane Library, Web of Science and Scopus databases were searched through January 2019. The quality of the included studies and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS) in accordance with the Cochrane guidelines. A random effects model and pooled odds ratios (OR) with 95%CI were applied for the quantitative meta-analysis.

RESULTS

We screened 2933 articles. Thirteen studies with 769 unique patients with GNEN1 were included. Overall, the rate of metastasis to locoregional LNs was 3.3% (25/769). The rate of LN metastases with a cut-off size of 10 mm was 15.3% for lesions > 10 mm (vs 0.8% for lesions < 10 mm) with a random-effects OR of 10.5 (95%CI: 1.4 -80.8; heterogeneity: P = 0.126; I2 = 47.5%). Invasion of the muscularis propria was identified as a predictor for LN metastases (OR: 17.2; 95%CI: 1.8-161.1; heterogeneity: P = 0.165; I2 = 44.5%), whereas grade was not clearly associated with LN metastases (OR: 2; 95%CI: 0.3-11.6; heterogeneity: P = 0.304; I2 = 17.4%). With regard to GNEN1 local recurrence, scarce data were available. The 5-year disease-specific survival for patients with and without LN metastases was 100% in most available studies irrespective of the type of intervention. Surgical resection was linked to a lower risk of recurrence (OR: 0.3; 95%CI: 0.1-1.1; heterogeneity: P = 0.173; I2 = 31.9%). The reported complication rates of endoscopic and surgical intervention were 0.6 and 3.8%, respectively.

CONCLUSION

This meta-analysis confirms that tumor size ‚Č• 10 mm and invasion of the muscularis propria are linked to a higher risk of LN metastases in patients with GNEN1. Overall, the metastatic propensity of GNEN1 is low with favorable 5-year disease-specific survival rates reported; hence, no clear evidence of the prognostic value of LN positivity is available. Additionally, there is a lack of evidence supporting the prediction of local recurrence in GNEN1, even if surgery was more often a definitive treatment.

Place, publisher, year, edition, pages
BAISHIDENG PUBLISHING GROUP INC , 2019. Vol. 25, no 35, p. 5376-5387
Keywords [en]
Gastric neuroendocrine neoplasms type 1, Meta-analysis, Lymph node metastasis, Tumor size, Invasion, Endoscopy, Surgery
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:uu:diva-395747DOI: 10.3748/wjg.v25.i35.5376ISI: 000487245400012PubMedID: 31558880OAI: oai:DiVA.org:uu-395747DiVA, id: diva2:1365255
Funder
Swedish Society of Medicine, SLS-785911Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2019-10-24Bibliographically approved

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