Nomogram predicting the risk of recurrence after curative-intent resection of primary non-metastatic gastrointestinal neuroendocrine tumors: An analysis of the U.S. Neuroendocrine Tumor Study Group

J Surg Oncol. 2018 Apr;117(5):868-878. doi: 10.1002/jso.24985. Epub 2018 Feb 15.

Abstract

Background: The risk of recurrence after resection of non-metastatic gastro-entero-pancreatic neuroendocrine tumors (GEP-NET) is poorly defined. We developed/validated a nomogram to predict risk of recurrence after curative-intent resection.

Methods: A training set to develop the nomogram and test set for validation were identified. The predictive ability of the nomogram was assessed using c-indices.

Results: Among 1477 patients, 673 (46%) were included in the training set and 804 (54%) in y the test set. On multivariable analysis, Ki-67, tumor size, nodal status, and invasion of adjacent organs were independent predictors of DFS. The risk of death increased by 8% for each percentage increase in the Ki-67 index (HR 1.08, 95% CI, 1.05-1.10; P < 0.001). GEP-NET invading adjacent organs had a HR of 1.65 (95% CI, 1.03-2.65; P = 0.038), similar to tumors ≥3 cm (HR 1.67, 95% CI, 1.11-2.51; P = 0.014). Patients with 1-3 positive nodes and patients with >3 positive nodes had a HR of 1.81 (95% CI, 1.12-2.87; P = 0.014) and 2.51 (95% CI, 1.50-4.24; P < 0.001), respectively. The nomogram demonstrated good ability to predict risk of recurrence (c-index: training set, 0.739; test set, 0.718).

Conclusion: The nomogram was able to predict the risk of recurrence and can be easily applied in the clinical setting.

Keywords: neuroendocrine tumors; nomogram; recurrence.

MeSH terms

  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Gastrointestinal Neoplasms / pathology*
  • Gastrointestinal Neoplasms / surgery
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / pathology*
  • Neoplasm Recurrence, Local / surgery
  • Neuroendocrine Tumors / pathology*
  • Neuroendocrine Tumors / surgery
  • Nomograms*
  • Prognosis
  • Risk Factors
  • Survival Rate