Clinical characteristics and long-term prognosis of type 1 gastric neuroendocrine tumors in a large Japanese national cohort

Ken Namikawa; Tomoari Kamada; Junko Fujisaki; Yuichi Sato; Takahisa Murao; Tsutomu Chiba; Yasuharu Kaizaki; Kenji Ishido; Yutaro Ihara; Koichi Kurahara; Tomoaki Suga; Haruhisa Suzuki; Masanori Ito; Katsuya Hirakawa; Yasuhiko Maruyama; Takuji Gotoda; Osamu Hosokawa; Tomohiro Koike; Katsuhiro Mabe; Takashi Yao; Kazuo Inui; Hiroyasu Iishi; Haruhiko Ogata; Takahisa Furuta; Ken Haruma; Collaborators

doi:10.1111/den.14529

Clinical characteristics and long-term prognosis of type 1 gastric neuroendocrine tumors in a large Japanese national cohort

Dig Endosc. 2023 Sep;35(6):757-766. doi: 10.1111/den.14529. Epub 2023 Mar 28.

Authors

Ken Namikawa^{1

2}, Tomoari Kamada^{3

2}, Junko Fujisaki^{1

2}, Yuichi Sato^{4

2}, Takahisa Murao^{3

2}, Tsutomu Chiba^{5

2}, Yasuharu Kaizaki^{6

2}, Kenji Ishido^{7

2}, Yutaro Ihara^{8

2}, Koichi Kurahara^{9

2}, Tomoaki Suga^{10

2}, Haruhisa Suzuki^{11

2}, Masanori Ito^{12

2}, Katsuya Hirakawa^{13

2}, Yasuhiko Maruyama^{14

2}, Takuji Gotoda^{15

2}, Osamu Hosokawa^{16

2}, Tomohiro Koike^{17

2}, Katsuhiro Mabe^{18

2}, Takashi Yao^{19

2}, Kazuo Inui^{20

2}, Hiroyasu Iishi^{21

2}, Haruhiko Ogata^{22

2}, Takahisa Furuta^{23

2}, Ken Haruma^{24

2}; Collaborators

Affiliations

¹ Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
² Research Group on the Treatment Guidelines for Gastric Carcinoids Associated with Autoimmune Gastritis in Japan, Tokyo, Japan.
³ Department of Health Care Medicine, Kawasaki Medical School, Okayama, Japan.
⁴ Department of Gastroenterology, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan.
⁵ Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁶ Department of Pathology, Fukui Prefectural Hospital, Fukui, Japan.
⁷ Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan.
⁸ Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁹ Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan.
¹⁰ Endoscopic Examination Center, Shinshu University, Nagano, Japan.
¹¹ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
¹² Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan.
¹³ Division of Gastroenterology, Fukuoka Red Cross Hospital, Fukuoka, Japan.
¹⁴ Division of Gastroenterology, Fujieda Municipal General Hospital, Shizuoka, Japan.
¹⁵ Department of Gastroenterology, Nihon University Hospital, Tokyo, Japan.
¹⁶ Department of Surgery, Yokohama Sakae Kyosai Hospital, Kanagawa, Japan.
¹⁷ Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
¹⁸ Junpukai Health Maintenance Center - Kurashiki, Okayama, Japan.
¹⁹ Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
²⁰ Department of Gastroenterology Yamashita Hospital, Aichi, Japan.
²¹ Department of Gastroenterology, Itami City Hospital, Hyogo, Japan.
²² Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan.
²³ Center for Clinical Research, Hamamatsu University School of Medicine, Shizuoka, Japan.
²⁴ Division of Gastroenterology, Department of Internal Medicine 2, Kawasaki Medical School, Okayama, Japan.

PMID: 36721901
DOI: 10.1111/den.14529

Abstract

Objectives: Optimal management of type 1 gastric neuroendocrine tumors (T1-GNETs) remains unknown, with few reports on their long-term prognosis. This study investigated the clinical characteristics and long-term prognosis of T1-GNETs.

Methods: We reviewed the medical records of patients diagnosed with T1-GNET during 1991-2019 at 40 institutions in Japan.

Results: Among 172 patients, endoscopic resection (ER), endoscopic surveillance, and surgery were performed in 84, 61, and 27, respectively, including 27, 77, and 2 patients with pT1a-M, pT1b-SM, and pT2 tumors, respectively. The median tumor diameter was 5 (range 0.8-55) mm. Four (2.9%) patients had lymph node metastasis (LNM); none had liver metastasis. LNM rates were significantly higher in tumors with lymphovascular invasion (LVI) (15.8%; 3/19) than in those without (1.1%; 1/92) (P = 0.016). For tumors <10 mm, LVI and LNM rates were 18.4% (14/76) and 2.2% (2/90), respectively, which were not significantly different from those of tumors 10-20 mm (LVI 13.3%; 2/15, P = 0.211; and LNM 0%; 0/17, P = 1.0). However, these rates were significantly lower than those of tumors >20 mm (LVI 60%; 3/5, P = 0.021; and LNM 40%; 2/5, P = 0.039). No tumor recurrence or cause-specific death occurred during the median follow-up of 10.1 (1-25) years. The 10-year overall survival rate was 97%.

Conclusions: Type 1 gastric neuroendocrine tumors showed indolent nature and favorable long-term prognoses. LVI could be useful in indicating the need for additional treatments. ER for risk prediction of LNM should be considered for tumors <10 mm and may be feasible for tumors 10-20 mm.

Trial registration: The study protocol was registered in the University Hospital Medical Information Network (UMIN) under the identifier UMIN000029927.

Keywords: Japanese large cohort; autoimmune gastritis; gastric carcinoid; prognosis; type 1 gastric neuroendocrine tumor.

MeSH terms

East Asian People
Humans
Lymphatic Metastasis
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Neuroendocrine Tumors* / surgery
Prognosis
Retrospective Studies
Risk Factors
Stomach Neoplasms* / pathology