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In a study reported in the Journal of the National Cancer Institute, Cives et al found that postsurgical relapse occurred in 31% of patients with stage I to III midgut neuroendocrine tumors over long-term follow-up, with liver, mesentery, and pelvic lymph nodes being the main sites of relapse.
Characteristics of Recurrence
The retrospective study included 129 patients treated at the Moffitt Cancer Center between 2000 and 2010 who underwent R0/R1 resection. Median postoperative follow-up was 81 months (range = 1–295 months). Recurrence was found in 40 patients (31.0%). Most recurrences were metastatic, with the liver (52.5%) and pelvic lymph nodes (15.0%) being the most common sites of distant relapse. Locoregional recurrences were observed in 13 patients (33.5%), with 11 observed in the mesentery and 2 in the small intestine.
Median disease-free survival was 138 months. Resection of ≤ 17 lymph nodes predicted relapse (P = .01) and shorter disease-free survival (median = 134 months vs not reached, P = .04). Among patients with relapse, the cumulative risk of recurrence at 1, 5, and 10 years was 15.0%, 50.0%, and 85.0%, respectively. No recurrences were observed among 6 patients with stage I disease, whereas similar rates of relapse were noted among the 118 with stage II (35.7%) or III disease (31.7%).
The investigators concluded: “An annual surveillance interval may allow early detection of recurrence. Given the apparent decline in recurrence after 8 years from surgery, a decade-long duration of active surveillance may be proposed.”


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