Abstract The role of primary tumor resection (PTR) in patients with metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs) undergoing peptide receptor radionuclide therapy (PRRT) remains uncertain. This meta-analysis evaluated whether PTR prior to PRRT is associated with improved survival outcomes compared to PRRT alone. MEDLINE, Embase, and the Cochrane Library were searched through November 19, 2024 (PROSPERO CRD42024605382). Eligible studies included metastatic GEP-NET patients treated with PRRT, with or without prior PTR. Data extraction was performed independently in duplicate following PRISMA guidelines. Risk of bias was assessed using the QUIPS tool. Hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS) were pooled using random-effects models. Five observational studies, involving 1,186 patients (649 with PTR before PRRT; 537 receiving PRRT alone), met the inclusion criteria. PTR prior to PRRT was associated with longer PFS (HR, 0.62; 95% CI, 0.42–0.91; I² = 45%) and OS (HR, 0.46; 95% CI, 0.33–0.65; I² = 0%). Given the observational design, confounding by indication and potential immortal-time bias were the primary sources of bias, though the overall risk was rated low to moderate. PTR before PRRT was associated with longer PFS and OS in metastatic, somatostatin receptor–positive GEP-NETs. These findings may indicate an association, but the low certainty of the observational evidence limits their interpretability. Future well-designed studies are required to confirm or refute this observation.
Orbán et al. (Wed,) studied this question.