Association of Surgery and Chemotherapy in Stage IV Gastroenteropancreatic Neuroendocrine Carcinoma

  • Author Footnotes
    1 Drs Wong and Dasari contributed equally to the study.
    William G. Wong
    1 Drs Wong and Dasari contributed equally to the study.
    Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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  • Author Footnotes
    1 Drs Wong and Dasari contributed equally to the study.
    Arvind Dasari
    1 Drs Wong and Dasari contributed equally to the study.
    Division of Cancer Medicine, Department of Gastrointestinal (GI) Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Chan Shen
    Corresponding author. Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, P. O. Box 850, Hershey, PA 17033-0850. Tel.: +717 531-7068.
    Division of Outcomes Research and Quality, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania

    Division of Health Services and Behavioral Research, Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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  • Author Footnotes
    1 Drs Wong and Dasari contributed equally to the study.
Published:November 23, 2022DOI:



      The survival benefit of chemotherapy for patients with metastatic gastroenteropancreatic neuroendocrine carcinomas (GEP-NECs) is well established. However, reasons for underutilization of chemotherapy are unknown.


      The National Cancer Database (NCDB) was queried for metastatic GEP-NECs from 2009 to 2016. The cohort was stratified by patients who had received chemotherapy and who did not receive chemotherapy. Demographic, socioeconomic, clinical, and treatment characteristics were captured. Multivariable logistic regression examined factors associated with chemotherapy utilization.


      Of the 2367 stage IV GEP-NECs patients identified, 1647 (69.6%) received chemotherapy. Patients with primary site at colon and small bowel, age ≥75, no insurance, and ≥2 comorbidities were less likely to receive chemotherapy than patients with other primary sites, age <75, private insurance, and no comorbidities (P < 0.005). The small bowel and colon were the primary sites with the greatest percentage of patients who received surgery (46.4% and 41.8%, respectively). In these subgroup of patients, surgical intervention was also associated with lower probability of receiving chemotherapy (odds ratio = 0.60, P < 0.005).


      About 30% of patients with metastatic GEP-NECs did not receive chemotherapy. Primary site location and receipt of surgery were significantly associated with receipt of chemotherapy, with NECs in small bowel and colon being more likely to receive surgery and less likely to receive chemotherapy. While surgery may be considered on an individual basis, increasing efforts to ensure patients with colon or small bowel NECs receive guideline-concordant chemotherapy will positively impact survival. In addition, interventions to improve health insurance coverage to increase receipt of chemotherapy are warranted.


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