| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Daskalakis, Kosmas, 1979-, et al.
(author)
-
MODIFIED HISTOPATHOLOGICAL GRADING OPTIMIZES PREDICTION OF SURVIVAL OUTCOMES IN SMALL INTESTINAL NEUROENDOCRINE TUMOURS
- 2024
-
In: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 111:Suppl. 4
-
Journal article (other academic/artistic)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
|
|
| 6. |
|
|
| 7. |
- Kanakis, G., et al.
(author)
-
Unusual Complication of a Pancreatic Neuroendocrine Tumor Presenting with Malignant Hypercalcemia
- 2012
-
In: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 97:4, s. E627-E631
-
Journal article (peer-reviewed)abstract
- Context: Hypersecretion of PTHrP is a relatively common cause of malignancy-related hypercalcemia but has only been described in a few cases of neuroendocrine tumors (NET). Objective: The aim of this case report is to describe the clinical syndrome, complex therapeutic interventions, and unusual complications caused by persistent PTHrP hypersecretion in a patient with a pancreatic NET. Case Illustration: A 58-yr-old male patient presented with nonspecific abdominal pain and was found to have severe hypercalcemia secondary to a well-differentiated NET of the pancreas associated with extensive liver metastases. Elevated ionized calcium levels accompanied by low serum PTH and remarkably elevated PTHrP concentrations were consistent with PTHrP-related hypercalcemia that proved to be resistant to various chemotherapeutic regimens and supportive therapy. Partial control of the humoral syndrome was obtained only after the application of cytoreductive interventions and the introduction of various molecular targeted therapies. Due to persistent PTHrP action, bone disease emerged in the form of brown tumors. Discussion: The manifestation of paraneoplastic syndrome due to PTHrP hypersecretion, despite its rareness in NET, should be considered in the differential diagnosis of hypercalcemia in such tumors. Moreover, the appearance of bone lesions in this setting may be in the context of metabolic bone disease and could be misdiagnosed as bone metastases.
|
|
| 8. |
- Karapanagioti, A., et al.
(author)
-
Aberrant expression pattern of circadian clock genes in type 1 gastric neuroendocrine neoplasms compared to ECL-cell hyperplasia
- 2021
-
In: Journal of neuroendocrinology (Print). - : European Neuroendocrine Association. - 0953-8194 .- 1365-2826. ; 33:S1, s. 37-37
-
Journal article (other academic/artistic)abstract
- Introduction: There is a continuity of changes from ECL-cell hyperplasia to type 1 gastric neuroendocrine neoplasms (GNEN1) development with important clinical implications. Aim(s): Although the effect of the circadian clock system on neuroendocrine tumorigenesis has been addressed, the role of the peripheral clock system in the transition from ECL-cell hyperplasia to GNEN1 remains to be explored.Materials and methods: Six GNEN1 patients and 10 patients with ECL-cell hyperplasia were included. Blood samples were collected at 8 am, 3pm and 10pm for peripheral blood mononuclear ells (PBMCs) isolation. The mRNA expression of clock-related genes (CLOCK, BMAL1, CRY-1, PER2, ROR-α and REV-ERBβ) were evaluated by real-time quantitative PCR from PBMCs. Results: In GNEN1 patients, BMAL genes where lower expressed at night than early in the morning (p=0.02), whereas patients with ECL-cell hyperplasia expressed lower levels of PER2 and REV-ERBβ (p=0.03 and p=0.05,respectively). In addition, GNEN1 patients expressed lower levels of CLOCK, PER2 and REV-ERBβ in the early evening than in the morning (p=0.04; p=0.03; p=0.05, respectively). When comparing the two groups (GNEN1 vs. ECL-cell hyperplasia) at the three different time points, a marginal increase in CLOCK, PER2 and REV-ERBβ expression early in the morning (p=0.06, 0.02 and 0.07, respectively) along with a marginal increase in REV-ERBβ and BMAL expression in the early evening (p=0.09 and p=0.08, respectively) and a marginal increase in BMAL at night (p=0.09) in GNEN1 patients was observed.Conclusion: Our findings point towards an upregulated expression of clock-related genes in patients with GNEN1 as compared to ECL-cell hyperplasia, suggesting a possible involvement in GNEN1 tumorigenesis that needs to be confirmed in a larger patients group.
|
|
| 9. |
- Wedin, M., 1977-, et al.
(author)
-
Virchow's node metastasis from small intestinal neuroendocrine neoplasms : A bi-center cohort study
- 2022
-
In: Journal of neuroendocrinology (Print). - : John Wiley & Sons. - 0953-8194 .- 1365-2826. ; 34:Suppl. 1, s. 88-88
-
Journal article (other academic/artistic)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.
|
|
| 10. |
- Ambrosini, Valentina, et al.
(author)
-
Consensus on molecular imaging and theranostics in neuroendocrine neoplasms
- 2021
-
In: European Journal of Cancer. - : Elsevier. - 0959-8049 .- 1879-0852. ; 146, s. 56-73
-
Research review (peer-reviewed)abstract
- Nuclear medicine plays an increasingly important role in the management neuroendocrine neoplasms (NEN). Somatostatin analogue (SSA)-based positron emission tomography/computed tomography (PET/CT) and peptide receptor radionuclide therapy (PRRT) have been used in clinical trials and approved by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA). European Association of Nuclear Medicine (EANM) Focus 3 performed a multidisciplinary Delphi process to deliver a balanced perspective on molecular imaging and radionuclide therapy in well-differentiated neuroendocrine tumours (NETs). NETs form in cells that interact with the nervous system or in glands that produce hormones. These cells, called neuroendocrine cells, can be found throughout the body, but NETs are most often found in the abdomen, especially in the gastrointestinal tract. These tumours may also be found in the lungs, pancreas and adrenal glands. In addition to being rare, NETs are also complex and may be difficult to diagnose. Most NETs are non-functioning; however, a minority present with symptoms related to hypersecretion of bioactive compounds. NETs often do not cause symptoms early in the disease process. When diagnosed, substantial number of patients are already found to have metastatic disease. Several societies' guidelines address Neuroendocrine neoplasms (NENs) management; however, many issues are still debated, due to both the difficulty in acquiring strong clinical evidence in a rare and heterogeneous disease and the different availability of diagnostic and therapeutic options across countries. EANM Focus 3 reached consensus on employing 68gallium-labelled somatostatin analogue ([68Ga]Ga-DOTA-SSA)-based PET/CT with diagnostic CT or magnetic resonance imaging (MRI) for unknown primary NET detection, metastatic NET, NET staging/restaging, suspected extra-adrenal pheochromocytoma/paraganglioma and suspected paraganglioma. Consensus was reached on employing 18fluorine-fluoro-2-deoxyglucose ([18F]FDG) PET/CT in neuroendocrine carcinoma, G3 NET and in G1-2 NET with mismatched lesions (CT-positive/[68Ga]Ga-DOTA-SSA-negative). Peptide receptor radionuclide therapy (PRRT) was recommended for second line treatment for gastrointestinal NET with [68Ga]Ga-DOTA-SSA uptake in all lesions, in G1/G2 NET at disease progression, and in a subset of G3 NET provided all lesions are positive at [18F]FDG and [68Ga]Ga-DOTA-SSA. PRRT rechallenge may be used for in patients with stable disease for at least 1 year after therapy completion. An international consensus is not only a prelude to a more standardised management across countries but also serves as a guide for the direction to follow when designing new research studies.
|
|
| 11. |
|
|
| 12. |
- Daskalakis, Kosmas, 1979-, et al.
(author)
-
Increased Autophagy/Mitophagy Levels in Pancreatic Neuroendocrine Neoplasms
- 2020
-
In: Neuroendocrinology. - : S. Karger. - 0028-3835 .- 1423-0194. ; 110:Suppl. 1, s. 7-7
-
Journal article (other academic/artistic)abstract
- Introduction: Autophagy and mitophagy are key homeostatic machineries linked to cancer development and drug resistance.Aim(s): To assess the levels of autophagy and mitophagy in well differentiated pancreatic neuroendocrine neoplasms (PanNENs) and correlate them with clinico-pathological parameters. Materials and methods: Fluorescent immunostaining for the autophagy markers LC3 Βand p62/or LAMP1 was performed on 22 PanNENs and 11 controls of normal pancreatic tissues and validated through Western blotting. Autophagy quantitative scoring was generated for LC3B-positive puncta and analyzed in relation to clinico-pathological parameters. TOMM20/LC3B qualitative assessment of mitophagy levels was undertaken by fluorescent immunostaining. The presence of autophagy/mitophagy was validated by transmission electron microscopy.Results: Autophagy levels (LC3B-positive puncta/cell) were discriminative for normal vs. NEN pancreatic tissue (p=0.007). A significant association was observed between autophagy levels and tumour grade (Ki67<3% vs. Ki67≥3%; p=0.021), but not functionality (p=0.266) size (cut-off of 20mm; p=0.808), local invasion (p=0.481), lymph node- (p=0.849) and distant metastases (p=0.699). Qualitative assessment of TOMM20/LC3B demonstrated strong mitophagy levels in PanNENs by fluorescent immunostaining as compared to normal tissue. Transmission electron microscopy revealed enhanced autophagy and mitophagy in PanNEN tissue. Response to molecular targeted therapies in metastatic cases (n=4) did not reveal any patterns of association to autophagy levels.Conclusion: Increased autophagy levels are present in primary tumours of patients with PanNENs and are partially attributed to upregulated mitophagy. Grade was the only clinico-pathological parameter associated with autophagy scores.
|
|
| 13. |
|
|
| 14. |
|
|
| 15. |
- Kaltsas, G., et al.
(author)
-
THE EFFECT OF PROPHYLACTIC RIGHT HEMICOLECTOMY ON SURVIVAL AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH WELL-DIFFERENTIATED APPENDICEAL NEUROENDOCRINE NEOPLASMS
- 2020
-
In: British Journal of Surgery. - : John Wiley & Sons. - 0007-1323 .- 1365-2168. ; 107:Suppl. 2, s. 14-14
-
Journal article (other academic/artistic)abstract
- Background: Long-term outcomes, including health-related quality of life (HRQoL) issues are understudied in patients with well-differentiated ppendiceal neuroendocrine neoplasms (WD-ANENs). We aimed to evaluate the validity of currently applied criteria for completion prophylactic right hemicolectomy (pRHC) and determine its association with patient outcomes.Methods: This cohort study included patients with WD-ANENs from five European Centers of Excellence for neuroendocrine tumors. Eligible patients were divided between those who underwent appendectomy alone and those who underwent pRHC. HRQoL EORTCqlqc30 questionnaires and cross-sectional imaging data were prospectively collected.Results: The 166 patients included 119 women (71.2%). Mean age was 31 ± 16 years. Mean follow-up was 51 ± 54 months. Most patients (152[92%]) had tumors≤20 mm. Fifty-eight patients (34.9%) underwent pRHC that was unnecessary in 65.5%(38/58); and in 79.1%(34/43) of tumors≤20 mm. In multivariable analysis, tumor size>20 mm was the only independent predictor for lymph node (LN) positivity(p = 0.021). No disease-specific mortality was reported. Three patients developed recurrence (n = 2inthepRHC group vs. n = 1 in the appendectomy group;p = 0.263). Although global HRQol was not significantly depreciated in patients undergoing pRHC compared to appendectomy alone (median scores 0.79[0.25-1] vs. 0.83[0.08-1], respectively; p = 0.738), impaired social functioning (p = 0.016), diarrhea (p = 0.003) and financial difficulties (0.024) were more frequently reported in the pRHC group. Furthermore, physical-(p = 0.066) and role functioning (p = 0.055), as well as constipation issues(p = 0.072) emerged in the pRHC group with marginal significance.Conclusion: pRHC in WD-ANENs comes at a high rate of unnecessary procedures, functional HRQoL issues and diarrhoea. LN positivity at pRHC may lack prognostic significance, as no disease-specific mortality and scarce recurrence was evident in this series. The validity of contemporary criteria and the value per se of pRHC to patients with WD-ANEN is challenged.
|
|
| 16. |
- Nesti, Cedric, et al.
(author)
-
Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1-2 cm in size : a retrospective, Europe-wide, pooled cohort study
- 2023
-
In: The Lancet Oncology. - : Elsevier. - 1470-2045 .- 1474-5488. ; 24:2, s. 187-194
-
Journal article (peer-reviewed)abstract
- BackgroundAwareness of the potential global overtreatment of patients with appendiceal neuroendocrine tumours (NETs) of 1–2 cm in size by performing oncological resections is increasing, but the rarity of this tumour has impeded clear recommendations to date. We aimed to assess the malignant potential of appendiceal NETs of 1–2 cm in size in patients with or without right-sided hemicolectomy.MethodsIn this retrospective cohort study, we pooled data from 40 hospitals in 15 European countries for patients of any age and Eastern Cooperative Oncology Group performance status with a histopathologically confirmed appendiceal NET of 1–2 cm in size who had a complete resection of the primary tumour between Jan 1, 2000, and Dec 31, 2010. Patients either had an appendectomy only or an appendectomy with oncological right-sided hemicolectomy or ileocecal resection. Predefined primary outcomes were the frequency of distant metastases and tumour-related mortality. Secondary outcomes included the frequency of regional lymph node metastases, the association between regional lymph node metastases and histopathological risk factors, and overall survival with or without right-sided hemicolectomy. Cox proportional hazards regression was used to estimate the relative all-cause mortality hazard associated with right-sided hemicolectomy compared with appendectomy alone. This study is registered with ClinicalTrials.gov, NCT03852693.Findings282 patients with suspected appendiceal tumours were identified, of whom 278 with an appendiceal NET of 1–2 cm in size were included. 163 (59%) had an appendectomy and 115 (41%) had a right-sided hemicolectomy, 110 (40%) were men, 168 (60%) were women, and mean age at initial surgery was 36·0 years (SD 18·2). Median follow-up was 13·0 years (IQR 11·0–15·6). After centralised histopathological review, appendiceal NETs were classified as a possible or probable primary tumour in two (1%) of 278 patients with distant peritoneal metastases and in two (1%) 278 patients with distant metastases in the liver. All metastases were diagnosed synchronously with no tumour-related deaths during follow-up. Regional lymph node metastases were found in 22 (20%) of 112 patients with right-sided hemicolectomy with available data. On the basis of histopathological risk factors, we estimated that 12·8% (95% CI 6·5 –21·1) of patients undergoing appendectomy probably had residual regional lymph node metastases. Overall survival was similar between patients with appendectomy and right-sided hemicolectomy (adjusted hazard ratio 0·88 [95% CI 0·36–2·17]; p=0·71).InterpretationThis study provides evidence that right-sided hemicolectomy is not indicated after complete resection of an appendiceal NET of 1–2 cm in size by appendectomy, that regional lymph node metastases of appendiceal NETs are clinically irrelevant, and that an additional postoperative exclusion of metastases and histopathological evaluation of risk factors is not supported by the presented results. These findings should inform consensus best practice guidelines for this patient cohort.
|
|
| 17. |
|
|
| 18. |
|
|
| 19. |
- Nikolaou, A., et al.
(author)
-
The value of C-11-5-hydroxy-tryptophan positron emission tomography in neuroendocrine tumor diagnosis and management : experience from one center
- 2010
-
In: Journal of Endocrinological Investigation. - 0391-4097 .- 1720-8386. ; 33:11, s. 794-799
-
Journal article (peer-reviewed)abstract
- Many neuroendocrine tumors (NET) are small and may escape localization by conventional imaging techniques. In such cases, C-11-5-hydroxy-tryptophan (C-11-5-HTP) positron emission tomography (PET) has been tested as an additional diagnostic tool. Nine patients with clinically, biochemically and/or histologically confirmed NET and negative computerized tomography (CT) or magnetic resonance imaging (MRI), and In-111-pentetreotide (Octreoscan) scintigraphy underwent imaging with C-11-5-HTP-PET/CT in order to: 1) detect the primary tumor lesion in three patients; 2) detect residual disease in two patients with appendiceal carcinoid, one with rectal carcinoid, one with midgut carcinoid, and one with ectopic ACTH secretion (EAS) due to residual pulmonary carcinoid; and 3) restage a patient with medullary thyroid carcinoma (MTC) and hepatic metastases. C-11-54HTP-PET/CT detected lesions in the mediastinum in a patient with EAS due to a pulmonary carcinoid, further hepatic metastases in a patient with carcinoid syndrome (CS) from a NET of unknown primary, further hepatic metastases in the patient with MTC, and hepatic metastases in the patient with midgut carcinoid. The C-11-5-HTP-PET/CT findings contributed to radical cure of the patient with recurrent EAS, and pointed towards bilateral adrenalectomy in the patient with EAS without evident primary tumor. In addition, C-11-5HTP-PET/CT directed towards combined surgical and medical treatment in the patient with CS and multiple rather than single hepatic metastases and in the patient with midgut carcinoid, and towards continuation of medical treatment in the patient with MTC. C-11-5-HTP-PET/CT is a useful imaging technique, providing additional information for the diagnosis, staging and decision-making regarding management of patients with NET.
|
|
| 20. |
|
|
| 21. |
|
|
| 22. |
- Tsoli, M., et al.
(author)
-
The efficacy of above-label doses of long-acting somatostatin analogues for the management of patients with gastroenteropancreatic tumors
- 2021
-
In: Journal of neuroendocrinology (Print). - : European Neuroendocrine Association. - 0953-8194 .- 1365-2826. ; 33:S1, s. 146-146
-
Journal article (other academic/artistic)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.
|
|
| 23. |
- Öberg, Kjell, 1946-, et al.
(author)
-
A meta-analysis of the accuracy of a neuroendocrine tumor mRNA genomic biomarker (NETest) in blood
- 2020
-
In: Annals of Oncology. - : Elsevier. - 0923-7534 .- 1569-8041. ; 31:2, s. 202-212
-
Research review (peer-reviewed)abstract
- Background: The lack of an accurate blood biomarker in neuroendocrine tumor (NET) disease has hindered management. The advance of genomic medicine and the development of molecular biomarkers has provided a strategy-liquid biopsy-to facilitate real-time management. We reviewed the role of a blood mRNA-based NET biomarker, the NETest, as an in vitro diagnostic (IVD).Patients and methods: A systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was undertaken. The methodological quality was evaluated using the QUADAS-2 tool. We identified ten original scientific papers that met the inclusion criteria. These were assessed by qualitative analysis and thereafter meta-analysis. Data were pooled and a median [95% confidence interval (CI)] diagnostic odds ratio (DOR), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were calculated. For the meta-analysis, a generic inverse variance method was undertaken using the accuracy and area under the curve (AUC) data.Results: The ten studies exhibited moderate to high methodological quality. They evaluated NETest usage both as a diagnostic and as a monitoring tool. The meta-analysis identified the diagnostic accuracy of the NETest to be 95%-96% with a mean DOR of 5 853, +LR of 195, and -LR of 0.06. The NETest was 84.5%-85.5% accurate in differentiating stable disease from progressive disease. As a marker of natural history, the accuracy was 91.5%-97.8%. As an interventional/response biomarker, the accuracy was 93.7%-97.4%. The pooled AUC for the NETest was 0.954 +/- 0.005, with a z-statistic of 175.06 (P < 0.001).Conclusions: The NETest is an accurate biomarker suitable for clinical use in NET disease management. The meta-analysis supports the utility of the NETest as an IVD to establish a diagnosis and monitor therapeutic efficacy. The use of this as a biomarker provides information relevant to NET management consistent with observations regarding utility of liquid biopsies in other oncological disciplines.
|
|
