Clinicopathological characteristics and prognosis of 232 patients with poorly differentiated gastric neuroendocrine neoplasms

BACKGROUND Poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)include gastric neuroendocrine carcinoma(NEC)and mixed adenoneuroendocrine carcinoma,which are highly malignant and rare tumors,and their incidence has increased over the past few decades.However,the clinicopathological features and outcomes of patients with PDGNENs have not been completely elucidated.AIM To investigate the clinicopathological characteristics and prognostic factors of patients with PDGNENs.METHODS The data from seven centers in China from March 2007 to November 2019 were analyzed retrospectively.RESULTS Among the 232 patients with PDGNENs,191(82.3%)were male,with an average age of 62.83±9.11 years.One hundred and thirteen(49.34%)of 229 patients had a stage III disease and 86(37.55%)had stage IV disease.Three(1.58%)of 190 patients had no clinical symptoms,while 187(98.42%)patients presented clinical symptoms.The tumors were mainly(89.17%)solitary and located in the upper third of the stomach(cardia and fundus of stomach:115/215,53.49%).Most lesions were ulcers(157/232,67.67%),with an average diameter of 4.66±2.77 cm.In terms of tumor invasion,the majority of tumors invaded the serosa(116/198,58.58%).The median survival time of the 232 patients was 13.50 mo(7,31 mo),and the overall 1-year,3-year,and 5-year survival rates were 49%,19%,and 5%,respectively.According to univariate analysis,tumor number,tumor diameter,gastric invasion status,American Joint Committee on Cancer(AJCC)stage,and distant metastasis status were prognostic factors for patients with PDGNENs.Multivariate analysis showed that tumor number,tumor diameter,AJCC stage,and distant metastasis status were independent prognostic factors for patients with PDGNENs.CONCLUSION The overall prognosis of patients with PDGNENs is poor.The outcomes of patients with a tumor diameter>5 cm,multiple tumors,and stage IV tumors are worse than those of other patients.

Impact and Clinical Predictors of Lymph Node Metastases in Nonfunctional Pancreatic Neuroendocrine Tumors

Background： The optimal surgical management of nonfunctional pancreatic neuroendocrine tumors （NF-PNETs） is still controversial. Here, we evaluated the impact of lymph node status on postoperative recurrence in patients with NF-PNET and the potential of preoperative variables for predicting lymph node metastasis （LNM）. Methods： In this mono-institutional retrospective cohort study conducted in 100 consecutive patients who underwent NF-PNET resection between January 2004 and December 2014, we evaluated risk factors for survival using the Kaplan-Meier method and the Cox regression model. Predictors of LNM were evaluated using the logistic regression model, and the power of predictive models was evaluated using receiver operating characteristic curve analysis. Results： Five-year disease-free survival of resected NF-PNET was 64.1%. LNM was independently associated with postoperative recurrence （hazard ratio = 3.995, P = 0.003）. Multivariate analysis revealed tumor grade as an independent factor associated with LNM （G2 vs. G I ： odds ratio [OR] =6.287, P- 0.008; G3 vs. G 1： OR = 12.407, P = 0.001）. When tumor grade was excluded, radiological tumor diameter 〉2.5 cm （OR = 5.430, P = 0.013） and presence of symptoms （OR = 3.366, P = 0.039） were significantly associated with LNM. Compared to neoplasms with radiological diameter 〉2.5 cm （32.1%）, tumors ≤2.5 cm had an obviously lower risk of LNM （7.7%）, indicating the reliability of this parameter in predicting LNM （area under the curve, 0.693）. Incidentally discovered NF-PNETs ≤2.5 cm were associated with a low-risk of LNM and excellent survival. Conclusions： LNM is significantly associated with postoperative recurrence. Radiological tumor diameter is a reliable predictor of LNM in NF-PNETs. Our results indicate that lymphadenectomy in small （≤2.5 cm） NF-PNETs is not routinely necessary.

A novel nomogram provides improved accuracy for predicting biochemical recurrence after radical prostatectomy

Background:Various prediction tools have been developed to predict biochemical recurrence(BCR)after radical prostatectomy(RP);however,few of the previous prediction tools used serum prostate-specific antigen(PSA)nadir after RP and maximum tumor diameter(MTD)at the same time.In this study,a nomogram incorporating MTD and PSA nadir was developed to predict BCR-free survival(BCRFS).Methods:A total of 337 patients who underwent RP between January 2010 and March 2017 were retrospectively enrolled in this study.The maximum diameter of the index lesion was measured on magnetic resonance imaging(MRI).Cox regression analysis was performed to evaluate independent predictors of BCR.A nomogram was subsequently developed for the prediction of BCRFS at 3 and 5 years after RP.Time-dependent receiver operating characteristic(ROC)curve and decision curve analyses were performed to identify the advantage of the new nomogram in comparison with the cancer of the prostate risk assessment post-surgical(CAPRA-S)score.Results:A novel nomogram was developed to predict BCR by including PSA nadir,MTD,Gleason score,surgical margin(SM),and seminal vesicle invasion(SVI),considering these variables were significantly associated with BCR in both univariate and multivariate analyses(P<0.05).In addition,a basic model including Gleason score,SM,and SVI was developed and used as a control to assess the incremental predictive power of the new model.The concordance index of our model was slightly higher than CAPRA-S model(0.76 vs.0.70,P=0.02)and it was significantly higher than that of the basic model(0.76 vs.0.66,P=0.001).Time-dependent ROC curve and decision curve analyses also demonstrated the advantages of the new nomogram.Conclusions:PSA nadir after RP and MTD based on MRI before surgery are independent predictors of BCR.By incorporating PSA nadir and MTD into the conventional predictive model,our newly developed nomogram significantly improved the accuracy in predicting BCRFS after RP.