title: Well-differentiated neuroendocrine neoplasia: relapse-free survival and predictors of recurrence after curative intended resections.
abstract: BACKGROUND
  Resection with curative intention is the cornerstone of treatment in patients with neuroendocrine tumors. A proportion of patients will relapse after R0 resection, but the factors predictive of recurrence are not well understood.
  
  
  METHODS
  A database established 1998 at the University Hospital Marburg was queried for all patients with documented R0 resection. Recurrence-free survival and overall survival were estimated using the Kaplan-Meier method. Uni- and multivariate analyses were performed.
  
  
  RESULTS
  180 patients with a median age of 52 years entered the analysis. We observed 77 recurrences after a median time of 2.9 years. 24% of the recurrences occurred later than 5 years after operation. Median recurrence-free survival of the whole cohort was 101 months. In univariate analysis grade by Ki-67, stage, high lymph node ratio and microangioinvasion were significant predictors of recurrence. On multivariate analysis these parameters were confirmed as independent prognostic parameters with stage and microangioinvasion being the most important predictors.
  
  
  CONCLUSIONS
  After R0 resection of neuroendocrine tumors, postoperative surveillance should be extended to at least 10 years. Patients with distant metastases and microangioinvasion are at high risk of recurrence. Clinical trials of adjuvant treatment protocols are indicated in these patients.
authors.affiliation: Department of Gastroenterology, University Hospital Marburg, Marburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Dieckhoff
authors.forename: H
authors.initials: H
authors.lastname: Runkel
authors.forename: H
authors.initials: H
authors.lastname: Daniel
authors.forename: D
authors.initials: D
authors.lastname: Wiese
authors.forename: A
authors.initials: A
authors.lastname: Koenig
authors.forename: V
authors.initials: V
authors.lastname: Fendrich
authors.forename: D K
authors.initials: DK
authors.lastname: Bartsch
authors.forename: R
authors.initials: R
authors.lastname: Moll
authors.forename: D
authors.initials: D
authors.lastname: Müller
authors.forename: R
authors.initials: R
authors.lastname: Arnold
authors.forename: T
authors.initials: T
authors.lastname: Gress
authors.forename: A
authors.initials: A
authors.lastname: Rinke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000628:therapy; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult