title: Prognostic factors for disease relapse in patients with neuroendocrine tumours who underwent curative surgery.
abstract: OBJECTIVE
  Surgery is the only modality of cure in patients diagnosed with neuroendocrine tumours (NETs). The aim of this study was to identify prognostic factors associated with disease relapse in patients with NETs treated by potentially-curative surgery.
  
  
  METHODS
  Sequential patients registered in The Christie European NET Society (ENETS) Centre of Excellence, with grade (G)1 or G2 NETs who had undergone curative surgery (February 2002-June 2014) were included. Investigated prognostic factors for relapse were: age, gender, TNM stage, tumour-localisation, functionality, genetic predisposition, presence of multiple NETs, second malignancy, grade (Ki-67-based), presence of vascular and/or perineural invasion, necrosis, surgical margin (R0/R1), Eastern Cooperative Oncology Group performance status and Adult Comorbidity Evaluation co-morbidity score.
  
  
  RESULTS
  One hundred and eighty-eight patients were identified [median age of 60 years (range 16-89)]. With a median follow-up of 2.6 years, 43 relapses occurred. The estimated median relapse-free survival (RFS) for the entire cohort was 8.0 years (95% confidence interval [CI] 5.9-10.0 years). In univariate analysis, primary NET location (p = 0.01), ENETS T-(HR-1.4; 95%-CI 1.0-2.0, p = 0.026), N-(HR-2.0, 95%-CI 1.1-3.9, p = 0.026) and M-stage (HR-2.6, 95%-CI 1.1-6.3, p = 0.052), grade (Ki-67%-based) (HR-2.5; 95%-CI 1.4-4.7; p = 0.003) and perineural invasion (HR-2.1; 95%-CI 1.1-3.9; p = 0.029) were prognostic for relapse. Factors remaining significant after multivariable analysis were tumour size (HR-1.67; 95%-CI 1.04-2.70; p = 0.03), nodal involvement (HR-2.61; 95%-CI 1.17-5.83; p = 0.013) and Ki-67 at the time of diagnosis (HR-1.93; 95%-CI 1.24-3.0; p = 0.002).
  
  
  CONCLUSIONS
  Size of tumour, lymph node involvement and Ki-67 were independent prognostic factors for relapse after potentially curative surgery in NET.
authors: Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK; University of Amsterdam, The Netherlands. Electronic address: a.e.slagter@amc.uva.nl.
authors: A E
authors: AE
authors: Slagter
authors: Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK. Electronic address: David.Ryder@christie.nhs.uk.
authors: D
authors: D
authors: Ryder
authors: Department of Pathology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK. Electronic address: Bipasha.Chakrabarty@christie.nhs.uk.
authors: B
authors: B
authors: Chakrabarty
authors: Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK. Electronic address: Angela.Lamarca@christie.nhs.uk.
authors: A
authors: A
authors: Lamarca
authors: Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK. Electronic address: Richard.Hubner@christie.nhs.uk.
authors: R A
authors: RA
authors: Hubner
authors: Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK. Electronic address: Was.Mansoor@christie.nhs.uk.
authors: W
authors: W
authors: Mansoor
authors: University of Manchester/Institute of Cancer Sciences, Oxford Road, Manchester, UK; Department of Surgery, Manchester Royal Infirmary, Central Manchester Foundation Trust, Oxford Road, Manchester, UK. Electronic address: Derek.O'Reilly@cmft.nhs.uk.
authors: D A
authors: DA
authors: O'Reilly
authors: Department of Surgical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK. Electronic address: Paul.Fulford@christie.nhs.uk.
authors: P E
authors: PE
authors: Fulford
authors: University of Amsterdam, The Netherlands; Department of Medical Oncology, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: h.klumpen@amc.uva.nl.
authors: H J
authors: HJ
authors: Klümpen
authors: Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK; University of Manchester/Institute of Cancer Sciences, Oxford Road, Manchester, UK. Electronic address: juan.valle@manchester.ac.uk.
authors: J W
authors: JW
authors: Valle
authors: Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK; University of Manchester/Institute of Cancer Sciences, Oxford Road, Manchester, UK. Electronic address: Mairead.McNamara@christie.nhs.uk.
authors: M G
authors: MG
authors: McNamara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Neuroendocrine tumour; Prognosis; Recurrence