Recurrence and metastatic potential in Type 1 gastric neuroendocrine neoplasms

Clin Endocrinol (Oxf). 2019 Oct;91(4):534-543. doi: 10.1111/cen.14055. Epub 2019 Jul 7.


Background: The aim of our study was to assess clinico-pathological and biochemical parameters of Type 1 Gastric Neuroendocrine Neoplasms (GNEN1) with respect to tumours propensity for recurrence and metastasis.

Methods: Hospital charts of GNEN1 patients were reviewed at a single tertiary referral centre.

Results: We included 114 consecutive patients (74 women; age at baseline 54.5 ± 12.7 years [mean ± SD]) with GNEN1. All tumours (n = 114) were well differentiated; Grade 1 (G1) accounted for 56 patients (49%), whereas 46 (40%) were Grade 2 (G2) and 12 (11%) of unknown Grade. Overall follow-up encompassed 45.3 ± 46 (mean ± SD) months in 84 patients who were subjected to annual surveillance; 44 (52%) developed recurrence in the stomach during follow-up with 22 experiencing multiple recurrences; three (2.6%) presented with metastases in locoregional lymph nodes (n = 3) and/or the liver (n = 2); No metastasis or death was reported during follow-up. Median recurrence-free survival (RFS) was 31 months (95% CI: 7.6-54.4). Among clinico-pathological and biochemical parameters investigated, endoscopic intervention compared with surgery (P-value = .009) and higher serum-gastrin levels (s-gastrin) at baseline and first-year follow-up were associated with recurrence (P-value = .022 and .003 respectively) and also shorter RFS (log-rank P = .009 for type of intervention and .014 for s-gastrin, respectively). Receiver Operator Curve analysis of s-gastrin levels at first-year follow-up for recurrence demonstrated an area under the curve of 0.702.

Conclusion: Despite the relatively high prevalence of G2 tumours, endoscopically and/or surgically treated GNEN1 remains an indolent disease with a low metastatic propensity and no disease-specific mortality reported in our series. Many patients though will experience local recurrence, warranting long-term endoscopic surveillance with s-gastrin biomarker being a complementary tool in recurrence prediction.

Keywords: Type 1 gastric neuroendocrine neoplasm; gastrin; recurrence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Disease-Free Survival
  • Female
  • Gastrins / blood
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / blood
  • Neoplasm Recurrence, Local / complications
  • Neoplasm Recurrence, Local / mortality
  • Neuroendocrine Tumors / blood
  • Neuroendocrine Tumors / complications*
  • Neuroendocrine Tumors / mortality
  • Neuroendocrine Tumors / pathology*
  • ROC Curve
  • Stomach Neoplasms / blood
  • Stomach Neoplasms / complications*
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / pathology*


  • Gastrins