Lymph Node Metastasis in the Prognosis of Gastroenteropancreatic Neuroendocrine Tumors

Jacob A. Martin, Richard R.P. Warner, Anne Aronson, Juan P. Wisnivesky, Michelle Kang Kim

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Objectives This study aimed to determine the prognostic use of the extent of lymph node (LN) involvement in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) by analyzing population-based data. Methods Patients in the Surveillance, Epidemiology, and End Results registry were identified with histologically confirmed, surgically resected GEP-NETs. We divided patients into 3 lymph node ratio (LNR) groups based on the ratio of positive LNs to total LNs examined: 0.2 or less, greater than 0.2 to 0.5, and greater than 0.5. Disease-specific survival was compared according to LNR group. Results We identified 3133 patients with surgically resected GEP-NETs. Primary sites included the stomach (11% of the total), pancreas (30%), colon (32%), appendix (20%), and rectum (7%). Survival was worse in patients with LNRs of 0.2 or less (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.2-2.0), greater than 0.2 to 0.5 (HR, 2.0; 95% CI, 1.6-2.5), and greater than 0.5 (HR, 3.1; 95% CI, 2.5-3.9) compared with N0 patients. Ten-year disease-specific survival decreased as LNR increased from N0 (81%) to 0.2 or less (69%), greater than 0.2 to 0.5 (55%), and greater than 0.5 (50%). Results were consistent for patients with both low- and high-grade tumors from most primary sites. Conclusions Degree of LN involvement is a prognostic factor at the most common GEP-NET sites. Higher LNR is associated with decreased survival.

Original languageEnglish
Pages (from-to)1214-1218
Number of pages5
Issue number9
StatePublished - 1 Oct 2017


  • carcinoid
  • gastroenteropancreatic neuroendocrine tumors
  • lymph nodes
  • neuroendocrine tumor
  • prognosis
  • survival analysis


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