Clinical and oncological outcomes of gastroduodenal neuroendocrine tumours after endoscopic resection in the Western setting - a target trial emulation.
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Mendes Francisco, Vieira Rafael José, Alípio Maria, Esposito Gianluca, Panzuto Francesco, Dell'Unto Elisabetta, Rodriguez-Santiago Enrique, Hernandez Alberto Velasco, Caracuel Ignacio Ruz, Neves Joana Camões, Ferreira Aníbal, Moll Frederic, Pioche Mathieu, Soares Elisa Gravito, Amaro Pedro, Souto Mariana, Xavier Sofia, Cotter José, Ponte Sofia, Silva Joana Alves, Magalhães Ricardo Küttner, Gomes Luís Correia, Laranjo Ana, Gomes Rute, Soares Caroline, Cardoso Ricardo, Gupta Sunil, Bourke Michael, Gonçalves Nuno, Ortigão Raquel, Libânio Diogo, Rimondi Alessandro, Murino Alberto, Despott Edward J, Tribonias Georgios, Zormpas Petros, Wartski Alice, Jacques Jeremie, Cecinato Paolo, Barbara Giovanni, Sassatelli Romano, Sereni Giuliana, Schaffitzel Katrin Marlene, Goelder Stefan, Calabrese Giulio, Sferrazza Sandro, Craciun Ana, Moura Miguel, Tornai Tamas, Tate David, Mavrogenis Georgios, Walter Benjamin, Uchima Hugo, Allgaier Hans-Peter, Berr Frieder, Frias Joana, Marques Margarida, Gullo Irene, Carneiro Fátima, O'Toole Dermot, Santos-Antunes João, Pinto Bernardo Sousa, Macedo Guilherme, Morais Rui
Аннотация
METHODS: We conducted a multinational retrospective study (24 centres, 10 Western countries) of consecutive patients undergoing ER of GD-NETs. The main evaluated outcomes were the frequency of curative resection and residual disease. Additional evaluated outcomes included R0 resection rate and local recurrence. We performed a target-trial emulation to compare endoscopic submucosal dissection (ESD), conventional endoscopic mucosal resection (C-EMR), and modified-EMR for these outcomes, while adjusting for potential cofounders.
RESULTS: We analysed 444 GD-NETs (304 gastric, 140 duodenal) from 434 patients (median follow-up of 36 months). The curative resection rate was 51.6% for gastric NETs and 33.6% for duodenal NETs. The residual disease rate was 19.0% for gastric NETs and 10.8% for duodenal NETs. GD-NET-related mortality was 0.2%. Target-trial emulation demonstrated that ESD, compared with C-EMR, achieved a significantly higher R0 resection (60.9% vs. 45.6%; risk difference=15.3 percent points [pp]) and lower risk of local recurrence at 4 (risk difference=12.0 pp) and 5 years (risk difference=14.3 pp). No significant differences were observed between the three ER approaches for other outcomes.
CONCLUSION: GD-NETs were associated with frequent non-curative ER resections, but low recurrence and tumour-related mortality. ESD achieved a higher adjusted R0 resection rate and lower local recurrence compared with C-EMR. These results support the refinement of not only the curative resection criteria but also patient and ER technique selection.