Primary tumor resection improves survival of gastrointestinal neuroendocrine carcinoma patients with nonresected liver metastases.

Chen, Qichen; Li, Kan; Rhodin, Kristen E; Masoud, Sabran J; Lidsky, Michael E; Cai, Jianqiang; Wei, Qingyi; Luo, Sheng; Zhao, Hong

Primary tumor resection improves survival of gastrointestinal neuroendocrine carcinoma patients with nonresected liver metastases.

dc.contributor.author	Chen, Qichen
dc.contributor.author	Li, Kan
dc.contributor.author	Rhodin, Kristen E
dc.contributor.author	Masoud, Sabran J
dc.contributor.author	Lidsky, Michael E
dc.contributor.author	Cai, Jianqiang
dc.contributor.author	Wei, Qingyi
dc.contributor.author	Luo, Sheng
dc.contributor.author	Zhao, Hong
dc.date.accessioned	2023-03-01T14:23:53Z
dc.date.available	2023-03-01T14:23:53Z
dc.date.issued	2023-02
dc.date.updated	2023-03-01T14:23:51Z
dc.description.abstract	Background The role of primary tumor resection (PTR) in the survival of gastrointestinal neuroendocrine carcinoma (GI-NEC) patients with liver metastases only remains poorly defined. Therefore, we investigated the impact of PTR on the survival of GI-NEC patients with nonresected liver metastases. Methods GI-NEC patients with a liver-confined metastatic disease diagnosed between 2016 and 2018 were identified in the National Cancer Database. Multiple imputations by chained equations were used to account for missing data, and the inverse probability of treatment weighting (IPTW) method was used to eliminate selection bias. Overall survival (OS) was compared by adjusted Kaplan-Meier curves and log-rank test with IPTW. Results A total of 767 GI-NEC patients with nonresected liver metastases were identified. Among all patients, 177 (23.1%) received PTR and had a significantly favorable OS before (median: 43.6 months [interquartile range, IQR, 10.3-64.4] vs. 8.8 months [IQR, 2.1-23.1], p < 0.001 in log-rank test) and after (median: 25.7 months [IQR, 10.0-64.4] vs. 9.3 months [IQR, 2.2-26.4], p < 0.001 in IPTW-adjusted log-rank test) the IPTW adjustment. Additionally, this survival advantage persisted in an adjusted Cox model (IPTW adjusted hazard ratio = 0.431, 95% confidence interval: 0.332-0.560; p < 0.001). The improved survival persisted in subgroups stratified by primary tumor site, tumor grade, and N stage, even in the complete cohort (excluding patients with missing data). Conclusions PTR led to improved survival for GI-NEC patients with nonresected liver metastases regardless of primary tumor site, tumor grade, and N stage. However, the decision for PTR should be made on an individualized basis following multidisciplinary evaluation.
dc.identifier.issn	0022-4790
dc.identifier.issn	1096-9098
dc.identifier.uri	https://hdl.handle.net/10161/26666
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	Journal of surgical oncology
dc.relation.isversionof	10.1002/jso.27213
dc.subject	National Cancer Database
dc.subject	gastrointestinal neuroendocrine carcinoma
dc.subject	liver metastases
dc.subject	primary tumor resection
dc.title	Primary tumor resection improves survival of gastrointestinal neuroendocrine carcinoma patients with nonresected liver metastases.
dc.type	Journal article
duke.contributor.orcid	Masoud, Sabran J\|0000-0002-7758-3545
duke.contributor.orcid	Wei, Qingyi\|0000-0002-3845-9445\|0000-0003-4115-4439
duke.contributor.orcid	Luo, Sheng\|0000-0003-4214-5809
pubs.organisational-group	Duke
pubs.organisational-group	School of Medicine
pubs.organisational-group	Staff
pubs.organisational-group	Basic Science Departments
pubs.organisational-group	Clinical Science Departments
pubs.organisational-group	Institutes and Centers
pubs.organisational-group	Biostatistics & Bioinformatics
pubs.organisational-group	Surgery
pubs.organisational-group	Duke Cancer Institute
pubs.organisational-group	Duke Clinical Research Institute
pubs.organisational-group	Surgical Oncology
pubs.publication-status	Published