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Centralization of Care and Histologic Grade alters Survival in Gastric Neuroendocrine Tumors
Renee Tholey*, Suraj Panjwani, Maureen D. Moore, Cheguevera Afaneh, Thomas J. Fahey, Rasa Zarnegar
Surgery, New York Presbyterian-Weill Cornell Medical College, New York, NY
Background:
Gastric Neuroendocrine Tumors (NETs) make up a small subset of gastrointestinal malignancies and survival prognosis is typically based upon American Joint Committee on Cancer (AJCC) staging. However, disparity of access to care and tumor biology has been highlighted to potentially alter outcomes independent of staging. We aimed to determine the impact of centralization of care and clinicopathologic features on patient outcomes.
Methods:
The National Cancer Database (NCDB) (2004-2012) was utilized to collect clinicopathologic and survival data for Gastric NETs. Survival outcomes were evaluated based on demographics, tumor histology and grading, staging, adjuvant therapy, and type of medical center.
Results:
There were 1,114 patients included in the analyses. Based on histological grade, five-year overall survival for well, moderately, and poorly differentiated tumors was 85%, 77%, and 67%, respectively (p=0.008). Unlike stage I (p<0.001) where poorly differentiated tumors had worse prognosis; for stages II, III and IV tumor grade did not affect survival (p=0.88, 0.56, 0.45). Academic medical centers had improved overall survival when compared to comprehensive community cancer centers (p=0.045). Academic medical centers and comprehensive community centers did not differ in approach regarding laparoscopic versus open surgery (p=0.27). There was no significant difference in lymph node procurement rates between academic and comprehensive community centers (p=0.73), nor was the rate of R0 resection (p=0.10). Adjuvant chemotherapy or radiation therapy was performed in only 14 patients.
Conclusion:
Histologic grade predicts five-year overall survival and may be used in addition to AJCC staging as a prognostic indicator for Gastric NETs. Although academic centers did not differ from comprehensive community cancer centers in regard to R0 resection rates or lymph node procurement rates, overall survival was significantly better, supporting the proposal that centralization of care improves outcomes in Gastric NETs.
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