Surgery with Radical Intent: Is There an Indication for G3 Neuroendocrine Neoplasms?


Surgery with Radical Intent: Is There an Indication for G3 Neuroendocrine Neoplasms?


Elettra Merola MD, PhD, Anja Rinke MD, Stefano Partelli MD, PhD, Thomas M. Gress MD, PhD, Valentina Andreasi MD, Attila Kollár MD, PhD, Aurel Perren MD, PhD, Emanuel Christ MD, PhD, Francesco Panzuto MD, PhD, Andreas Pascher MD, PhD, Henning Jann MD, Ruza Arsenic MD, Birgit Cremer MD, Daniel Kaemmerer MD, Patrizia Kump MD, Rainer W. Lipp MD, Abbas Agaimy MD, Bertram Wiedenmann MD, PhD, Massimo Falconi MD, PhD & Marianne E. Pavel MD, PhD 



While platinum-based chemotherapy represents the standard treatment for advanced grade 3 (G3) neuroendocrine neoplasms (NENs) according to the European Neuroendocrine Tumor Society guidelines, the role of radical-intended surgery in these patients, as well as the use of adjuvant chemotherapy, are still controversial. The aim of the present work is to describe, in a retrospective series of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) G3, the overall survival (OS) rate and risk factors for death after radical surgery. Secondary aims are the description of median recurrence-free survival (RFS) and of the role of adjuvant chemotherapy.

Patients and Methods

Multicenter analysis of a series of stage I–III GEP-NEN G3 patients receiving radical surgery (R0/R1) with/without adjuvant chemotherapy was performed.


Sixty patients from eight neuroendocrine tumor (NET) referral centers, with median follow-up of 23 months (5–187 months) were evaluated. While 28.6% of cases had NET G3, 71.4% had neuroendocrine carcinoma G3 (NEC G3). The 2-year OS rate after radical surgery was 64.5%, with a statistically significant difference in terms of Ki67 threshold (cut-off 55%, P = 0.03) and tumor differentiation (NEC G3 vs. NET G3, P = 0.03). Median RFS after radical surgery was 14 months, and 2-year RFS rate was 44.9%. Use of adjuvant chemotherapy provided no benefit in terms of either OS or RFS in this series.


Surgery with radical intent might represent a valid option for GEP-NEN G3 patients with locoregional disease, especially with Ki67 value ≤ 55%.

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Year 2020
Language English
Format PDF
DOI 10.1245/s10434-019-08049-5