title: Localized high-grade gastroenteropancreatic neuroendocrine tumors: Defining prognostic and therapeutic factors for a disease of increasing clinical significance.
abstract: BACKGROUND
  Due to the limited sample size in the existing series, the natural history and management of high-grade gastroenteropancreatic neuroendocrine tumors (GEP-NET) is poorly understood. In order to better understand high-grade GEP-NET, a large cohort study was undertaken.
  
  
  OBJECTIVE
  To determine the prognostic factors associated with high-grade GEP-NET.
  
  
  METHODS
  Patients diagnosed with non-metastatic high-grade GEP-NET from 1988 to 2010 were identified in SEER.
  
  
  RESULTS
  Incidence of high-grade GEP-NETs increased from 0.03 to 0.19/100,000 over the study period. The median age was 65 years, and the majority of the patients were white and females. The most common primary site was colorectal, and the most frequent T classification was T3. Surgical resection was performed in 89% of patients that varied by site (p < 0.0001). Nodal involvement was frequent and varied by site (p = 0.0002). The 5-year disease-specific survival was 63.3% and was the greatest for small bowel (p = 0.0003). Survival was associated with age, node status and surgery (p < 0.05). On multivariate analysis, the node status, surgery, and site continued to be associated with survival (p < 0.05); however, age (p = 0.08) no longer influenced the patient's survival.
  
  
  CONCLUSIONS
  High-grade GEP-NETs are neoplasms with exponentially increasing in incidence. Tumor location and nodal status are predictors of survival. Surgery is associated with a survival advantage and could be considered for localized disease.
authors.affiliation: East Carolina University, Brody School of Medicine, Division of Surgical Oncology, Greenville, NC, USA.
authors.forename: C
authors.initials: C
authors.lastname: Mosquera
authors.affiliation: East Carolina University Brody School of Medicine, Greenville, NC, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Koutlas
authors.affiliation: East Carolina University, Brody School of Medicine, Division of Surgical Oncology, Greenville, NC, USA. Electronic address: fitzgeraldt@ecu.edu.
authors.forename: T L
authors.initials: TL
authors.lastname: Fitzgerald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007414:Intestinal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy
keywords: High-grade gastroenteropancreatic neuroendocrine tumors; Incidence; Prognostic factors; Survival