Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Assessing the Relationship Between Gastrointestinal and Pancreatic Neuroendocrine Tumor Grade and Overall Survival: A Systematic Review and Meta-Analysis

Version 1 : Received: 1 March 2023 / Approved: 3 March 2023 / Online: 3 March 2023 (06:59:20 CET)

A peer-reviewed article of this Preprint also exists.

Malik, P.; Patel, N.; Khayyat, A.; Asad, M.; Dawoodi, S.; Chandramohan, S.; Unachukwu, N.; Nasyrlaeva, B.; Vaisyambath, L.; Chowdary, S.B.; Venkata, V.S.; Patel, U. Assessing the Relationship between Gastrointestinal and Pancreatic Neuroendocrine Tumor Grade and Overall Survival: A Systematic Review and Meta-Analysis. Gastrointest. Disord. 2023, 5, 408-418. Malik, P.; Patel, N.; Khayyat, A.; Asad, M.; Dawoodi, S.; Chandramohan, S.; Unachukwu, N.; Nasyrlaeva, B.; Vaisyambath, L.; Chowdary, S.B.; Venkata, V.S.; Patel, U. Assessing the Relationship between Gastrointestinal and Pancreatic Neuroendocrine Tumor Grade and Overall Survival: A Systematic Review and Meta-Analysis. Gastrointest. Disord. 2023, 5, 408-418.

Abstract

Background: Neuroendocrine tumors (NET) are a rare group of epithelial neoplasm present in gastrointestinal tract (GI) (67.5%), bronchopulmonary tree (25.3-30%), and in 15% of cases, the primary sites cannot be identified. Although endoscopic screening, improvement in pathological techniques, and early detection have shown improvement in NET survival rates, the prognosis of advanced, metastatic, and poorly differentiated NET is very poor. In this study, we aimed to evaluate the effect of Gastrointestinal and pancreatic (GEPs) NETs grade on overall survival. Method: We searched observational studies describing the overall survival or prognostic factors of primary GEP NETs from May 2011 -May 2021 following PRISMA guidelines. Studies describing the effect of primary grade 3 GEP NETs on overall survival were included. Meta-analysis was performed, and pooled hazard ratio and their 95% confidence interval (95% CI) were obtained. The forest plots were created using random-effects models and sensitivity analysis was performed to account for the heterogeneity. Results: Seven studies with 7692 confirmed patients were included. In our meta-analysis grade 3 GEP NET were associated with higher odds of poor survival (pooled HR: 2.73; 95% CI: 1.36–5.47; p = 0.005), with 92% heterogeneity between studies (p < 0.0001). To account for heterogeneity, sensitivity analysis was performed by removing two outlying studies (Fathi et al. and Foubert et al.) on funnel plots. The results after sensitivity analysis did not change and still showed significant association of grade 3 with poor survival (pooled HR: 4.53; 95% CI: 3.54–5.78; p < 0.00001), with no heterogeneity between studies (p = 0.72; I2 = 0%). Conclusion: Our meta-analysis found that grade 3 GEP NETs are associated with poor survival and additional future studies are needed to identify other risk factors associated with poor survival in GEP NETs to improve mortality.

Keywords

Neuroendocrine tumors; survival; meta-analysis; NET; gastropancreatic NET; systemic review

Subject

Medicine and Pharmacology, Oncology and Oncogenics

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