De-escalating chemotherapy for stage I-II gastric neuroendocrine carcinoma - A real-world competing risk analysis

Sep 28, 2026

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Adjuvant chemotherapy in stage I–II gastric neuroendocrine neoplasms remains insufficiently defined. This study evaluates the potential effect of adjuvant chemotherapy in stage I–II GNEC patients and develops a predictive nomogram. Stage I–II GNEC cases were extracted from the SEER database and separated into chemotherapy and no-chemotherapy groups, then analyzed with Kaplan–Meier, propensity score matching, and competing risk methods. Results show comparable cancer-specific survival after PSM and no significant association between chemotherapy and cancer-specific death in multivariable competing risks regression.

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CategoryHealthcare

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Du et al. World Journal of Surgical Oncology (2023) 21:142 [https://doi.org/10.1186/s12957-023-03029-2](https://doi.org/10.1186/s12957-023-03029-2) World Journal of Surgical Oncology RESEARCH Open Access De-escalating chemotherapy for stage I–II gastric neuroendocrine carcinoma? A real-world competing risk analysis Danwei Du1, Yangyang Xie1, Xiaowen Li1, Zhongkai Ni1, Jinbo Shi1 and Hai Huang1* Abstract Background The role of adjuvant chemotherapy in gastric neuroendocrine neoplasms (GNEC) has not been well clarified yet. The study was designed to investigate the potential effect of adjuvant chemotherapy in stage I–II GNEC patients and construct a predictive nomogram. Method Stage I–II GNEC patients were included in the Surveillance, Epidemiology, and End Results (SEER) database and divided into chemotherapy and no-chemotherapy groups. We used Kaplan–Meier survival analyses, propensity score matching (PSM), and competing risk analyses. The predictive nomogram was then built and validated. Results Four hundred four patients with stage I–II GNEC were enrolled from the SEER database while 28 patients from Hangzhou TCM Hospital were identified as the external validation cohort. After PSM, similar 5-year cancer-specific survival was observed in two groups. The outcomes of competing risk analysis indicated a similar 5-year cumulative incidence of cancer-specific death (CSD) between the two cohorts (35 .4% vs. 31.4%, p = 0. 731) . And there was no significant relation between chemotherapy and CSD in the multivariate competing risks regression analysis (HR, 0 . 79; 95% CI, 0 .48–1. 31; p = 0. 36) . Furthermore, based on the variables from the multivariate analysis, a competing event nomogram was created to assess the 1-, 3-, and 5-year risks of CSD. The 1-, 3-, and 5-year area under the receiver operating characteristic curve (AUC) values were 0 . 770, 0 . 759, and 0.671 in the training cohort, 0 . 809, 0 . 782, and 0.735 in the internal validation cohort, 0 . 786, 0 . 856, and 0.770 in the external validation cohort. Furthermore, calibration curves revealed that the expected and actual probabilities of CSD were relatively consistent. Conclusion Stage I–II GNEC patients could not benefit from adjuvant chemotherapy after surgery. De-escalation of chemotherapy should be considered for stage I–II GNEC patients. The proposed nomogram exhibited excellent prediction ability. Keywords SEER Program, Nomogram, Chemotherapy, Gastric cancer, Competing risk analyses *Correspondence: Hai Huang [szyyhuanghai@163.com](szyyhuanghai@163.com) 1 Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou 310000, China Introduction Gastric cancer (GC) is a highly heterogeneous malignancy, including various pathologies which present significantly different molecular patterns, tumor behavior, and prognoses [1] . Gastric neuroendocrine carcinoma (GNEC) is a rare histology type of GC, which occupies 0.1 to 0.6% of whole patients, with an increasing trend over the past few decades [2] . GNEC is a poorly © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/

FAQs

What is the study’s main objective?

To investigate the potential effect of adjuvant chemotherapy in stage I–II gastric neuroendocrine neoplasm patients and to construct a predictive nomogram.

How were patients selected and compared?

Stage I–II GNEC patients were included from the SEER database, divided into chemotherapy and no-chemotherapy groups, and balanced using propensity score matching.

What did competing risk analyses show about chemotherapy and cancer-specific death?

Competing risk outcomes indicated similar 5-year cumulative incidence of cancer-specific death between cohorts, and multivariable competing risk regression found no significant relationship between chemotherapy and cancer-specific death.

Sep 28, 2026

Uploaded by Levi