Publication Details
Abstract
Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) represent a diverse group of neoplasms arising from the neuroendocrine system within the gastrointestinal and pancreatic tissues. Despite their relatively rare occurrence, the clinico-pathological understanding of GEP-NETs is crucial for effective management.
Aim of the study: This study aims to bridge the existing knowledge gaps by investigating the epidemiology, histopathology, and clinical manifestations of GEP-NETs within the Iraqi population.
Patients and methods: A cross-sectional multicentric study conducted at Oncology teaching hospital, Al-Amal national hospital, and Al-Yarmouk teaching hospital from March 10 to November 1, 2023, involved 50 patients with gastroenteropancreatic neuroendocrine tumors. The study covered demographics, symptoms, and histopathological details, including tumor characteristics, size, grade, differentiation, and stage. Additionally, assessments included mitotic rate, Ki67 proliferation index, and neuroendocrine marker immunohistochemical positivity.
Results: Average age was 50.4 years, predominantly males (60.0%). The most prevalent symptom was abdominal pain (86%), followed by diarrhea and flushing. Tumor characteristics indicated an average size of 4.7 cm², with 64.0% being well-differentiated. Two-thirds of cases had stage IV disease, all featuring liver metastasis. Long-acting release somatostatin analogue was the primary treatment in 74.0% of cases. Pancreatic tumors were most common (50%), followed by small intestine and appendix tumors. Significant associations were found between tumor site and each of the age, tumor stage, and metastasis (p-value of 0.016, 0.015 and 0.011, respectively); while higher grades correlated with larger size, advanced stage, poor differentiation, tumor metastasis, and elevated biomarker levels. A strong positive correlation existed between Ki67 and mitotic rate.
Conclusion: In Iraqi patients with GEP-NET, the pancreas was the most frequent site, followed by the small intestine and appendix. Most of the cases had metastasis. Higher tumor grades were correlated with larger size, advanced stage, and worse prognosis. Long-acting release somatostatin analogue (LAR) emerged as the most commonly used medication for NET treatment.