Comparable long-term survival outcomes of endoscopic therapy versus surgical therapy for T1-2N0M0 duodenal neuroendocrine tumors

Abstract

Background and study aims: The optimal treatment modality for T1-2N0M0 duodenal neuroendocrine tumors (DNETs) is still controversial. In this study, long-term survival outcomes were compared between the endoscopic therapy and surgical therapy for T1-2N0M0 DNETs using the Surveillance, Epidemiology, and End Results (SEER) database.

Patients and methods: Patients with DNETs from the SEER database were selected from 2004 to 2015. We used the Kaplan-Meier method and log-rank test to compare long-term survival results between the endoscopic therapy and surgical therapy. An analysis of the multivariable Cox proportional hazards model was performed to identify risk factors for patient prognoses. The 1:1 propensity score matching (PSM) was performed to balance baseline data.

Results: A total of 816 patients with DNETs were included, of which 578 patients (70.8%) received endoscopic therapy and 238 patients (29.2%) received surgical therapy. Before the PSM, there was no difference between the two groups of patients with DNETs on long-term survival [5-year OS (86.1% vs. 87.9%, P = 0.45), 10-year OS (72.5% vs. 72.3%, P = 0.45)]. After adjusting covariates, we found endoscopic therapy and surgical therapy groups had comparable risks of overall survival (HR 0.86, 95% CI 0.60-1.23, P = 0.409) and cancer-specific survival (HR 1.68, 95% CI 0.74-3.83, P = 0.214). In the post-PSM analysis, there was no discernible difference between the endoscopic therapy and surgical therapy group.

Conclusions: Our study found that for T1-2N0M0 DNETs patients, whose long-term OS and CSS results were similar for the endoscopic and surgical therapy groups. For these patients, endoscopic resection might be an optimal therapy modality.

Keywords: Duodenal; Endoscopy; Neuroendocrine tumors; SEER database; Surgery.