Progression after endoscopic treatment for type I gastric neuroendocrine tumors: A single-center retrospective study

doi:10.3748/wjg.v32.i8.114268

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World Journal of Gastroenterology

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1007-9327

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Retrospective Study

World J Gastroenterol. Feb 28, 2026; 32(8): 114268
Published online Feb 28, 2026. doi: 10.3748/wjg.v32.i8.114268

Progression after endoscopic treatment for type I gastric neuroendocrine tumors: A single-center retrospective study

Ze-Liang Yang, Hui-Ke Wang, Yong Liu, Li-Zhou Dou, Yue-Ming Zhang, Hoi-Ioi Ng, Shun He, Yihe-Bali Chi, Gui-Qi Wang

Ze-Liang Yang, Yong Liu, Li-Zhou Dou, Yue-Ming Zhang, Hoi-Ioi Ng, Shun He, Gui-Qi Wang, Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Hui-Ke Wang, Yihe-Bali Chi, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Co-first authors: Ze-Liang Yang and Hui-Ke Wang.

Co-corresponding authors: Yihe-Bali Chi and Gui-Qi Wang.

Author contributions: Yang ZL and Wang HK participated in the conception and design of the study and were involved in the acquisition, analysis, or interpretation of data, they contributed equally to this manuscript and are co-first authors; Liu Y, Dou LZ, Zhang YM, Ng HI, and He S were involved in the acquisition, analysis, or interpretation of data; Yang ZL wrote the manuscript; Chi YB and Wang GQ accessed and verified the study data, they contributed equally to this manuscript and are co-corresponding authors. All authors critically reviewed and provided final approval of the manuscript; and all authors were responsible for the decision to submit the manuscript for publication.

Supported by the CAMS Innovation Fund for Medical Sciences, No. 2021-I2M-1-061, No. 2021-I2M-1-013, and No. 2021-1-I2M-015.

Institutional review board statement: This investigation was approved by the Ethics Committee of National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College in accordance with the ethical standards outlined in the 1964 Helsinki Declaration and its subsequent amendments.

Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Gui-Qi Wang, MD, PhD, Academic Fellow, Professor, Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. wangguiq@126.com

Received: September 23, 2025
Revised: November 7, 2025
Accepted: January 4, 2026
Published online: February 28, 2026
Processing time: 141 Days and 18.5 Hours

Abstract

BACKGROUND

Endoscopic treatment is the primary therapy for type I gastric neuroendocrine tumors (G-NETs), but it may not address the underlying pathogenesis, increasing the risk of progression.

AIM

To investigate the effectiveness of endoscopic treatment and identify progression risk factors.

METHODS

This retrospective study involved 128 patients with type I G-NETs treated between January 2009 and May 2024. The patients were categorized into non-progressive (n = 87) and progressive (n = 41) groups. Baseline characteristics, treatment details, and follow-up data were analyzed using univariate and multivariate Cox regression analyses to identify prognostic variables.

RESULTS

The baseline characteristics analysis showed no significant differences between the groups. The median follow-up time was 25.5 months (14.00-58.50 months). The univariate and multivariate analyses confirmed that endoscopic treatment combined with adjuvant somatostatin analogs (SSAs) was associated with a lower risk of progression (hazard ratio = 0.38, 95% confidence interval: 0.17-0.90, P = 0.027), whereas a neutrophil-to-lymphocyte ratio (NLR) of ≥ 2 indicated a higher risk (hazard ratio = 2.14, 95% confidence interval: 1.08-4.26, P = 0.030). Kaplan-Meier analysis confirmed NLR ≥ 2 and adjuvant SSA use as independent prognostic variables.

CONCLUSION

Combining endoscopic treatment with SSAs is effective for managing type I G-NETs. SSAs and NLR were identified as independent prognostic factors, highlighting their potential to reduce recurrence risk and improve outcomes.

Keywords: Type I gastric neuroendocrine tumors; Endoscopic treatment; Neutrophil-to-lymphocyte ratio; Prognosis; Somatostatin analogues

Core Tip: Endoscopic treatment is the standard therapy for type I gastric neuroendocrine tumors, but it may not address underlying disease mechanisms. In this retrospective study of 128 patients, 41 experienced progression. Multivariate Cox regression identified adjuvant somatostatin analog use as a protective factor (hazard ratio = 0.38, 95% confidence interval: 0.17-0.90, P = 0.027) and neutrophil-to-lymphocyte ratio ≥ 2 as a risk factor (hazard ratio = 2.14, 95% confidence interval: 1.08-4.26, P = 0.030). Kaplan-Meier analysis confirmed both as independent prognostic variables. These findings suggest that combining endoscopic therapy with somatostatin analogues improves outcomes. Neutrophil-to-lymphocyte ratio may serve as a simple marker to guide risk stratification.