AbstractBackground.High‐grade neuroendocrine carcinomas are rare in the gastrointestinal tract. However, treatment patterns and outcomes have not been well described.Subjects, Materials, and Methods.The National Cancer Database was analyzed. The primary objective was to describe the clinical outcomes and identify prognostic factors. Univariate and multivariate analyses were done to identify factors associated with patient outcome.Results.A total of 1,861 patients were identified between 2004 and 2013. The mean age was 63 years (standard deviation ±13). The majority of the patients (78.1%) were non‐Hispanic whites. The most common primary sites were pancreas (pancreatic neuroendocrine tumor [PNET] = 19.4%), large intestine (18.1%), esophagus (17.8%), and rectum (15.5%). Stage at presentation was I (6.6%), II (10.5%), III (18%) and IV (64.6%). Only 1.6% of the patients had brain metastases. Surgical resection was the primary therapy in 27.9%, and their median overall survival (OS) was 13.3 months. Patients treated with palliative chemotherapy had a median OS of 11.2 months, compared with 1.7 months for untreated patients. The median OS for high‐grade PNET was 6 months, compared with 9.9 months for other high‐grade gastrointestinal neuroendocrine carcinomas (HG GI NEC). On univariable analysis, age < 65 years (hazard ratio [HR] 0.72; 0.66–0.8; p < .001) and treatment at an academic center (HR 0.88; 0.79–0.99; p < .034) were associated with improved survival. Multivariable analysis confirmed prognostic advantage of treatment at an academic center.Conclusion.This is the largest series of HG GI NEC. Most patients present with metastatic disease, and overall survival remains poor. Treatment at an academic center, younger age, and use of chemotherapy were associated with improved survival. Multiagent chemotherapy was found to be associated with superior survival compared with single‐agent chemotherapy, which was superior to no chemotherapy. Temporal sequences of chemotherapy, surgery, and radiation administration were not found to be associated with survival differences on multivariable analysis.Implications for Practice.Management of patients with high‐grade gastrointestinal neuroendocrine carcinomas (HG GI NEC) is based on experience with small‐cell lung cancer. In this retrospective review, most patients had advanced disease and pancreatic primary had worse outcomes. Treatment at an academic center, younger age, and use of chemotherapy are associated with improved survival. Patients with early‐stage disease treated with resection alone had inferior outcomes compared with patients who received neoadjuvant or adjuvant therapy, suggesting that micrometastases contribute to poor surgical outcomes. The relatively high proportion of positive surgical margin favors downstaging with neoadjuvant therapy to improve resection and lower the risk of systemic recurrence.
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Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com
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- Change in endolymphatic hydrops 2 years after endo...
- Mycotoxins in poultry feed and feed ingredients in...
- A Systematic Review and Meta-Analysis of Subsequen...
- Role of Leucine 341 in Thyroid Hormone Receptor Be...
- How Should Thyroid-Related Quality of Life Be Asse...
- An Age-Specific Serum Thyrotropin Reference Range ...
- Comparison of Iodine Concentrations in Kitchen Sal...
- Smartphone telemedical emergency department consul...
- Antileukotrienes improve naso‐ocular symptoms and ...
- Automated Quantification of Vocal Fold Motion in a...
- Surgery of the major salivary glands and its impac...
- Missing canines: a novel aetiology
- Patient reported outcome measures in forty‐three p...
- Induction of smell through transethmoid electrical...
- Therapeutic use of steroids in non–chronic rhinosi...
- Ivacaftor improves rhinologic, psychologic, and sl...
- Interleukin‐4‒induced posttranscriptional gene reg...
- Cutaneous adverse events associated with purine an...
- IgA deposition in a vegetating plaque on the glans...
- A cross‐sectional study of YouTube videos about ps...
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- Oral benign neoplasms: A retrospective study of 79...
- The lncRNA H19/miR-675 axis regulates myocardial i...
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- Tumor-infiltrating immune cell subpopulations and ...
- Vocal cord immobility as a cause of aphonia in a c...
- Pediatric Ewing Sarcoma of the Head and Neck: A Re...
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- 7-Tesla MRI of the brain in a research subject wit...
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- Long-Term Outcomes of Bilateral Pallidal Deep Brai...
- Novel HAX1 Gene Mutation in a Vietnamese Boy with ...
- Bericht vom 12. Kongress der European Laryngologic...
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- Histopathological Findings and Increased D-Dimer A...
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- Heavily Pigmented Epithelioid Melanoma With Loss o...
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Τρίτη 27 Νοεμβρίου 2018
High‐Grade Gastrointestinal Neuroendocrine Carcinoma Management and Outcomes: A National Cancer Database Study
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- Subject Index
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- Prelims
- Diagnosis and Management of Immune Checkpoint Inhi...
- High‐Grade Gastrointestinal Neuroendocrine Carcino...
- A family with PTEN mutations with malignancy and a...
- Omalizumab discontinuation in children with severe...
- Change in endolymphatic hydrops 2 years after endo...
- Mycotoxins in poultry feed and feed ingredients in...
- A Systematic Review and Meta-Analysis of Subsequen...
- Role of Leucine 341 in Thyroid Hormone Receptor Be...
- How Should Thyroid-Related Quality of Life Be Asse...
- An Age-Specific Serum Thyrotropin Reference Range ...
- Comparison of Iodine Concentrations in Kitchen Sal...
- Smartphone telemedical emergency department consul...
- Antileukotrienes improve naso‐ocular symptoms and ...
- Automated Quantification of Vocal Fold Motion in a...
- Surgery of the major salivary glands and its impac...
- Missing canines: a novel aetiology
- Patient reported outcome measures in forty‐three p...
- Induction of smell through transethmoid electrical...
- Therapeutic use of steroids in non–chronic rhinosi...
- Ivacaftor improves rhinologic, psychologic, and sl...
- Interleukin‐4‒induced posttranscriptional gene reg...
- Cutaneous adverse events associated with purine an...
- IgA deposition in a vegetating plaque on the glans...
- A cross‐sectional study of YouTube videos about ps...
- Squamous cell carcinoma of the nail unit: a retros...
- Differentiation of acquired port wine stain and an...
- The use of electrochemotherapy in combination with...
- Skin disorders are prominent features in primary i...
- Distinct Lipid Transfer Proteins display different...
- Increased expression of L‐plastin in nasal polyp o...
- How to discontinue omalizumab in chronic spontaneo...
- Clinical Snippets
- Issue Information
- Membrane‐enriched solute carrier family 2 member 1...
- Student Elective Competition 2018/19: A call for e...
- Guselkumab in the treatment of severe Hidradenitis...
- Trigger finger in a hereditary multiple exostoses ...
- Microvascular Capillary Plexus Findings of Commoti...
- Severe vemurafenib‐induced photosensitivity in a 6...
- Higher circulating androgens and higher physical a...
- Highlights and recent developments in airway disea...
- Erratum: Eingewachsene Zehennägel – Optionen für d...
- Estrogen associated with UVB irradiation recapitul...
- Estrogen associated with UVB irradiation recapitul...
- Oral benign neoplasms: A retrospective study of 79...
- The lncRNA H19/miR-675 axis regulates myocardial i...
- Genetic and environmental influences on third mola...
- Tumor-infiltrating immune cell subpopulations and ...
- Vocal cord immobility as a cause of aphonia in a c...
- Pediatric Ewing Sarcoma of the Head and Neck: A Re...
- Glucocorticoid insensitivity by staphylococcal ent...
- TRPV1 mediates inflammation and hyperplasia in imi...
- 7-Tesla MRI of the brain in a research subject wit...
- Pigmented villonodular synovitis occurring in the ...
- What to know about hyperpigmentation
- What to know about hyperpigmentation
- Gender Disparities in Trauma Care: How Sex Determi...
- Evaluating a shortened interpretation criterion fo...
- Diagnosis and treatment of oropharyngeal dysphagia...
- Exceptional responses to pertuzumab, trastuzumab, ...
- Massive aneurysmal bone cyst of the skull base tre...
- DiODe: Directional Orientation Detection of Segmen...
- Comparative Study of Robot-Assisted versus Convent...
- Long-Term Outcomes of Bilateral Pallidal Deep Brai...
- Novel HAX1 Gene Mutation in a Vietnamese Boy with ...
- Bericht vom 12. Kongress der European Laryngologic...
- Dermoscopy of lipidised dermatofibroma: A morpholo...
- Dermoscopy of lipidised dermatofibroma: A morpholo...
- Pruritic Linear Eruption in a 53-Year-Old Woman: A...
- Histopathological Findings and Increased D-Dimer A...
- The “Line Sign” Is a Rapid and Efficient Diagnosti...
- Impact of Dermoscopy and Reflectance Confocal Micr...
- Expanding the Morphologic Heterogeneity of Stromal...
- Ewing-Like Sarcoma: A Case of a Primary Cutaneous ...
- Late-Onset Facial Papular Elastorrhexis
- Campbell de Morgan Spots (Cherry Angiomas) Show En...
- Whole Slide Imaging
- Oncocytic Metaplasia in Melanocytic Tumors
- Pruritic Linear Eruption in a 53-Year-Old Woman: C...
- Plexiform Atypical Spitz Tumor With Rosette-Like G...
- Primary Visceral Merkel Cell Carcinoma: A Case Rep...
- Vulvar Tuberculosis Cutis Orificialis Concomitant ...
- Facial Plaque in a Woman With Sjogren Syndrome: An...
- Heavily Pigmented Epithelioid Melanoma With Loss o...
- Verrucous Intertriginous Plaques: Answer
- Trichoblastic Carcinosarcoma of the Skin: A Case R...
- Is Immunohistochemical Screening of Cutaneous Leio...
- Atypical Varicella-Zoster Kaposi Varicelliform Eru...
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