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- Daskalakis, Kosmas, 1979-, et al.
(författare)
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MODIFIED HISTOPATHOLOGICAL GRADING OPTIMIZES PREDICTION OF SURVIVAL OUTCOMES IN SMALL INTESTINAL NEUROENDOCRINE TUMOURS
- 2024
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Ingår i: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 111:Suppl. 4
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: We aimed to identify optimal grading Ki-67 cut-offs to delineate differences in prognosis of patients with small intestinal neuroendocrine tumours (SI-NETs) in terms of overall- and event-free survival rates.Methods: We included 551 patients with SI-NETs diagnosed from June 15th, 1993, through March 8th, 2021, identified using the SI-NET databases from five European referral centers.Results: Median age at baseline was 62.3(17-90) years; 252 patients were women (45.7%). All tumours were well-differentiated; 326 were G1 tumours (59.2%), 169 G2(30.7%), only 8 G3(1.5%), while 48 tumourswere of unspecified grade (8.7%). The median Ki67 was 2%(1-70%). 247 patients(44.8%) had distant metastases at baseline (stage IV), 217locoregional disease (41.1%; stage III), whereas 29(7.1%) and 25(4.5%) presented at stages II and I, respectively. Within a mean(SD) follow-up of 51.5(52.9) months, 94 patients(17.1%) died, whereas overall 188 experienced disease recurrence, progression and/or death(34.1%). The median OS was 214.7(95%CI: 152.7-276.6) months and the median EFS was 79.8(95%CI: 68.2-91.5) months, respectively. In multivariable Cox-regression OS analysis, age (HR=1.07, 95%CI: 1.04-1.09; p<0.001), Charlson Comorbidity Index(HR=1.1, 95%CI: 1.03-1.17; p=0.006) and the proposed modified histopathological Ki67 grading system(K67:5-10% group: HR=2.4, 95%CI: 1.3-4.5; p=0.007 and K67≥10% group: HR=5.1, 95%CI: 2.9-9.2; p<0.001) were independent predictors for death. Pertinent EFS analysis, confirmed age(HR=1.04, 95%CI: 1.02-1.05;p<0.001) and the proposed modified histopathological Ki67 grading system(K67≥10% group: HR=4; 95%CI:2.5-6.2;p<0.001) as independent predictors for recurrence, progression and/or death.Conclusions: Ki-67 proliferation index is an independent predictor of EFS and OS. A modified site-specific histopathological grading system applying Ki-67 cut-offs of 5% and 10% seems more optimal to predict differences in SI-NET patient prognosis
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- Wedin, M., 1977-, et al.
(författare)
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Virchow's node metastasis from small intestinal neuroendocrine neoplasms : A bi-center cohort study
- 2022
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Ingår i: Journal of neuroendocrinology (Print). - : John Wiley & Sons. - 0953-8194 .- 1365-2826. ; 34:Suppl. 1, s. 88-88
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Small Intestinal Neuroendocrine Neoplasms (SI-NENs) may rarely metastasize to the left supraclavicular lymph nodes, also known as Virchow’s node metastasis (VM).Aim(s): Data on prevalence, prognostic significance and clinical course of disease for SI-NEN patients with VM is limited.Materials and methods: In this retrospective analysis of 231 SI-NEN patients treated at two tertiary referal centers we found nine patients with VM. We used a control group of 18 age-and sex-matched SI-NEN patients from the same cohort with stage IV disease, but no extrahepatic metastases.Results: VM prevalence was 3.9% (9/231; 5 females, median age at VM diagnosis 65 years). Two patients had G1, 5 G2 tumours and 2 of unspecified grade. Four patients presented with synchronous VM, whereas 3 developed metachronous VM after a median of 24 months (range: 4.8–117.6 months). Hepatic metastases were present in 7 patients, extrahepatic metastases (EM) in 8 (6 para-aortic distant lymph node metastases, 1 lung and 1 pancreatic metastasis) and peritoneal carcinomatosis in 2 patients. There was no difference in best-recorded responses to 1st line treatment according to RECIST 1.1 as well as progression-free (PFS) and overall survival rates (PFS) between patients with VM and those in the control group (Chi-square p=0.516; PFS: 71.7 vs. 106.9 months [95%CI 38.1-175.8]; log-rank p=0.855; OS: 138.6 [95%CI 17.2–260] vs. 109.9 [95%CI 91.7–128] months; log-rank p=0.533).Conclusion: VM is relatively rare in patients with SI-NENs. It is more often encountered in patients withG2 tumors and EM, mainly to distant para-aortic lymph nodes. Its presence does not seem to impact patients’ survival outcomes and treatment responses, when compared to age-and sex-matched patients with stage IV disease.
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- Tsoli, M., et al.
(författare)
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The efficacy of above-label doses of long-acting somatostatin analogues for the management of patients with gastroenteropancreatic tumors
- 2021
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Ingår i: Journal of neuroendocrinology (Print). - : European Neuroendocrine Association. - 0953-8194 .- 1365-2826. ; 33:S1, s. 146-146
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Above-label doses of long-acting somatostatin analogues (SSAs) are increasingly used for the control of secretory syndrome or as anti-proliferative treatment in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs).Aim(s): The aim of this study was to evaluate the anti-proliferative effect of increased dose of SSAs in patients with GEP-NETs.Materials and methods: We collected retrospectively the data of patients with GEP-NETs that received SSAs every 3 or 2 weeks, after disease progression on standard 4-weekly doses. We analysed clinical, biochemical and radiographic response data and identified factors that may influence the outcome.Results: We analysed the data of 16 patients. 7 patients suffered from pancreatic NET (pNET) and 9 from small intestinal NET (si-NET). Indications for dose increase were radiographic progression (62,5%), increasing biomarkers (12,5%) or inadequate syndrome control (25%). Among patients with radiographic progression before the escalation of SSA dose, 3 had disease stabilization and 7 eventually progressed radiographically. Median PFSwas 36 months. PNETs were associated with a significantly lower PFS compared to si-NETs (P= 0.041). Patients with NET with a Ki-67 labelling index≤5 displayed a significantly higher PFS (P= 0.047). No significant difference was observed between patients who received above-label SSAs due to clinical/biochemical or radiographic response (P=0.1). In univariate analysis, the Ki-67≤5 was marginally associated with significantly longer PFS (P=0.05).Conclusion: The administration of above-label doses of SSAs maybe a valuable option in patients who progress on the standard 4-weekly regimen, especially in patients with si-NETs or a Ki-67 labelling index≤5.
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