ArticleFrontiers in oncology2026
Association of primary-site surgery with survival in patients with metastatic gastroenteropancreatic neuroendocrine carcinoma: a population-based SEER study (2004-2023).
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Evidence regarding the association between primary tumor surgery and survival in metastatic gastroenteropancreatic neuroendocrine carcinoma (GEP-NEC) remains limited, and whether this association varies across patient subgroups is unclear. This study evaluated the associations between primary tumor surgery and overall survival (OS) and cancer-specific survival (CSS), and explored potential heterogeneity in effects. Methods: Patients diagnosed with distant metastatic GEP-NEC between 2004 and 2023 were identified from the SEER database and classified according to receipt of primary tumor surgery. One-to-one propensity score matching (PSM) was used to balance demographic, clinicopathological, and treatment-related variables. OS and CSS were compared using Kaplan-Meier analysis and Cox proportional hazards models. Sensitivity analyses, E-value analysis, and subgroup interaction analyses were performed to assess robustness and treatment-effect heterogeneity. Results: Among 4, 033 eligible patients, 786 underwent surgery, and 3, 247 did not. After PSM, 353 patients remained in each group. In the matched cohort, surgery was associated with longer median OS (26.0 vs. 8.0 months, P<0.001) and CSS (29.0 vs. 9.0 months, P<0.001). In the fully adjusted Cox model, surgery was associated with lower all-cause mortality (HR = 0.47, 95% CI: 0.40-0.56, P<0.001) and cancer-specific mortality (HR = 0.46, 95% CI: 0.39-0.54, P<0.001). Results were consistent across sensitivity analyses and remained robust in E-value analysis. Subgroup analyses showed stronger surgery-survival associations among patients who did not receive chemotherapy and, for CSS, among those with tumors <50 mm. Conclusion: Primary tumor surgery was associated with longer OS and CSS in selected patients with distant metastatic GEP-NEC, particularly those without chemotherapy or with smaller primary tumors.
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