Clinical Characteristics and Long-term Outcomes of Gastric Neuroendocrine Tumors

Background/aims: Gastric neuroendocrine tumors (GNETs), once rare, have become more prevalent due to the increased use of endoscopy and increased physician awareness. The clinical characteristics and long-term outcomes of GNET management were explored in this study.

Methods: The clinical data of 69 patients who treated at Seoul National University Hospital between January 2013 and October 2023 were retrospectively studied. Baseline characteristics, recurrence rates, associated factors, and overall survival rates were analyzed.

Results: Of the tumors, 71.0% were grade 1, 24.6% were grade 2, 1.4% were grade 3, and 2.9% were poorly differentiated. In terms of tumor type, 69.6% were type I, 1.4% were type II, and 29.0% were type III. A significant proportion of patients with grade 1 tumors received more endoscopic treatment, whereas a significant proportion of patients with grade 2 tumors underwent surgery or chemotherapy (p=0.015). The overall 5-year survival and recurrence rates were 93.8% and 7.25% (5/69), respectively. Among five patients who experienced recurrence, three had metachronous recurrence, all of which were type I; the remaining two patients exhibited distant hepatic metastasis, encompassing types I and III. The time to recurrence was 1 to 9.8 years. Margin positivity (p=0.002) and invasion deeper than the submucosal layer (p=0.007) were associated with higher recurrence rates. However, there was no significant association between recurrence and intestinal metaplasia, atrophic gastritis, or Helicobacter pylori infection.

Conclusions: Most patients with GNETs in this study had grade I and type I tumors, and the overall prognosis was favorable. Patients with risk factors for recurrence warrant further investigation. Those presenting margin positivity or deep invasion after resection should be closely monitored and undergo follow-up examinations, as necessary.