Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2017; 23(3): 516-524
Published online Jan 21, 2017. doi: 10.3748/wjg.v23.i3.516
Clinicopathological, treatment, and prognosis study of 43 gastric neuroendocrine carcinomas
De-Jun Liu, Xue-Liang Fu, Wei Liu, Lu-Ying Zheng, Jun-Feng Zhang, Yan-Miao Huo, Jiao Li, Rong Hua, Qiang Liu, Yong-Wei Sun
De-Jun Liu, Xue-Liang Fu, Wei Liu, Jun-Feng Zhang, Yan-Miao Huo, Jiao Li, Rong Hua, Yong-Wei Sun, Department Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Lu-Ying Zheng, Qiang Liu, Department Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Author contributions: Liu DJ, Fu XL and Liu W wrote the paper; Zheng LY, Zhang JF, Huo YM and Li J collected the data; Liu DJ, Fu XL, Liu W and Zheng LY performed the data analysis; Hua R, Liu Q and Sun YW designed the study and revised the paper; all authors have read and approved the final version to be published.
Supported by Chinese Society of Clinical Oncology, No. Y-N2013-014.
Institutional review board statement: The research was approved by the Research Ethics Committee of Ren Ji Hospital and comply with ethical standards.
Informed consent statement: Due to the retrospective nature of the study, patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to receive surgery, postoperative chemotherapy and the other medical treatment by written informed consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yong-Wei Sun, PhD, Biliary-Pancreatic Surgery Department, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No 1630 Dong Fang Road, Shanghai 200127, China. syw0616@yeah.net
Telephone: +86-21-68383773 Fax: +86-21-68383699
Received: October 10, 2016
Peer-review started: October 13, 2016
First decision: November 21, 2016
Revised: December 5, 2016
Accepted: December 16, 2016
Article in press: December 19, 2016
Published online: January 21, 2017
Processing time: 95 Days and 15.4 Hours
Abstract
AIM

To provide more information and therapeutic methods about gastric neuroendocrine carcinomas (G-NECs) which occur rarely but are highly malignant and clinically challenging.

METHODS

We retrospectively analyzed the clinicopathological characteristics, treatments, and prognosis of 43 G-NEC patients at our hospital between January 2007 and December 2014. The diagnosis was based on the 2010 World Health Organization criteria.

RESULTS

Forty-three G-NECs containing 39 small cell carcinomas and 4 large cell NECs with Ki67 > 60% were included in this study, accounting for only 0.95% of all gastric carcinomas. The median patient age was 62 years (range, 33-82) and the male-to-female ratio was 4.4:1. All patients underwent surgery, including 38 curative resections and 5 palliative resections. Among these 43 patients, nearly half (48.84%) of these tumors were located in the cardiac region of the stomach, regional lymph node metastasis was found in 31 cases (72.09%), and liver metastasis was found in 6 cases (13.95%). Follow-up information was got for 40 patients. Twenty-three die of this disease with a median survival of 31 mo (range 1-90). The 1-year, 2-year, 3-year, and 5-year survival rate was 77.50%, 57.04%, 44.51%, and 35.05%, respectively. Survival was better in patients with tumor located in the cardiac region of the stomach, less than 7 lymph nodes metastasis and no liver metastasis. Five patients did not undergo postoperative chemotherapy, and the median survival time for these patients was 15 mo. For the remaining 34 patients who received postoperative chemotherapy, the median survival time was 44 mo and those received etoposide, cisplatin, and Paclitaxel survived the best. One patient with resected liver metastasis who received postoperative Capecitabine plus Oxaliplatin and Paclitaxel systemic chemotherapy plus octreotide LAR (30 mg intramuscularly, every 4 wk, for 2 years) has survived for 74 mo with no recurrence.

CONCLUSION

G-NECs are mostly nonfunctioning, which lead to a delay in detection. Local and/or distant metastases were noticed in most patients when diagnosed, and they required postoperative medical treatment. Adjuvant etoposide, cisplatin plus Paclitaxel systemic chemotherapy is recommended for these patients.

Keywords: Gastric neuroendocrine carcinomas; Liver metastasis; Medical treatment; Surgery; Prognosis

Core tip: This is a retrospective study to provide more information and therapeutic methods about gastric neuroendocrine carcinomas. In this study we found that local and/or distant metastases were noticed in most patients when diagnosed, and they required postoperative medical treatment. Adjuvant etoposide, cisplatin plus Paclitaxel systemic chemotherapy is recommended for these patients.