Management Strategies and Outcomes for Type 1 Gastric Neuroendocrine Tumors Measuring More Than 1 cm
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Type 1 gastric neuroendocrine tumors (T1g-NETs) are well-differentiated lesions with excellent survival but frequent recurrence. Tumor size is the main prognostic factor, yet optimal management for tumors >1 cm remains uncertain. This study aimed to evaluate treatment strategies and outcomes in patients with T1g-NETs>1 cm. METHODS: We conducted a retrospective multicenter study including 106 adults with T1g-NETs >1 cm. Clinicopathologic and management data were collected. The primary outcome event was a composite unfavorable outcome, defined as recurrence or progression, used to analyze progression-free survival (PFS) as the main time-to-event outcome. Analyses included multinomial logistic regression, Cox models, and Kaplan-Meier curves ( P < 0.05). RESULTS: Among 106 patients (58.5% female; median age 59), median tumor size was 15 mm. Most tumors were Grade 1 (61.4%) or Grade 2 (37.7%), with median Ki-67 of 2%. Endoscopic resection was performed in 76 patients (71.7%), surgery in 33 (31.1%, including 13 initially treated endoscopically), and 10 (9.4%) were surveilled. Over a median 61-month follow-up, 24 patients (22.6%) recurred, 8 (7.5%) progressed; only 2 deaths (1.9%) were tumor-related. Larger tumors were associated with unfavorable outcome ( P = 0.005), with lesions ≥24 mm predicting shorter PFS (hazard ratio 3.93; P < 0.001). Endoscopic submucosal dissection and modified-endoscopic mucosal resection were associated with a significantly longer PFS ( P = 0.004). R0 resection showed a borderline protective effect. Five-year overall survival approached 95%. DISCUSSION: T1g-NETs > 1 cm frequently recur and may exhibit aggressive potential, particularly when lesions are larger. When endoscopic resection is feasible, endoscopic submucosal dissection or modified-endoscopic mucosal resection should be preferred to optimize outcomes.
Authors: Elisabetta Dell’Unto, Rajaventhan Srirajaskanthan, Christos Toumpanakis, Louis de Mestier, Dermot O'Toole, Davide Campana, D. Mark Pritchard, Marco Marini, Gianluca Esposito, Maria Rinzivillo, Dalvinder Mandair, Aman Saini, Klaire Exarchou, Giuseppe Lamberti, Grégoire Salin, Barra Neary, Alberto Murino, Edward John Despott, Bruno Annibale, Martyn Caplin, Francesco Panzuto
Institutions: The Royal Free Hospital, Azienda Ospedaliera Sant'Andrea, University College London, Sapienza University of Rome, King's College Hospital, Université Paris Cité, Hôpital Beaujon, Trinity College Dublin, St. Vincent's University Hospital, St. James's Hospital, University of Bologna, University of Liverpool, National Research Council, Institute of Cognitive Sciences and Technologies, Cleveland Clinic London
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,800
OpenAlex ID: W7203654299