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Lung Metastases in Patients with Well-Differentiated Gastroenteropancreatic Neuroendocrine Neoplasms : An Appraisal of the Validity of Thoracic Imaging Surveillance
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- Daskalakis, Kosmas (author)
- Uppsala universitet,Endokrinkirurgi,Univ Athens, Dept Propauped Internal Med 1, Endocrine Oncol Unit, Laiko Hosp, Athens, Greece
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- Tsoli, Marina (author)
- Univ Athens, Dept Propauped Internal Med 1, Endocrine Oncol Unit, Laiko Hosp, Athens, Greece
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- Srirajaskanthan, Raj (author)
- Kings Coll Hosp London, Neuroendocrine Tumour Unit, Kings Coll Hosp, KHP ENETS Ctr Excellence,Dept Gastroenterol, London SE5 9RS, England
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- Chatzellis, Eleftherios (author)
- Univ Athens, Dept Propauped Internal Med 1, Endocrine Oncol Unit, Laiko Hosp, Athens, Greece
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- Alexandraki, Krystallenia (author)
- Univ Athens, Dept Propauped Internal Med 1, Endocrine Oncol Unit, Laiko Hosp, Athens, Greece
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- Angelousi, Anna (author)
- Univ Athens, Dept Propauped Internal Med 1, Endocrine Oncol Unit, Laiko Hosp, Athens, Greece
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- Pizanias, Michail (author)
- Kings Coll Hosp London, Dept Liver Transplantat, Inst Liver Studies,Hepatobiliary Pancreat Surg, Kings Healthcare Partners,NHS FT, Denmark Hill, London, England
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- Randeva, Harpal (author)
- Univ Warwick, Warwick Med Sch, Clin Sci Res Labs, Univ Hosp, Coventry, W Midlands, England;Coventry Univ, Ctr Appl Biol & Exercise Sci, Fac Hlth & Life Sci, Coventry, W Midlands, England
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- Kaltsas, Gregory (author)
- Univ Athens, Dept Propauped Internal Med 1, Endocrine Oncol Unit, Laiko Hosp, Athens, Greece;Univ Warwick, Warwick Med Sch, Clin Sci Res Labs, Univ Hosp, Coventry, W Midlands, England;Coventry Univ, Ctr Appl Biol & Exercise Sci, Fac Hlth & Life Sci, Coventry, W Midlands, England
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- Weickert, Martin O. (author)
- Univ Hosp Coventry & Warwickshire NHS Trust, ARDEN NET Ctr, European Neuroendocrine Tumour Soc ENETS, Ctr Excellence CoE, Coventry, W Midlands, England;Univ Warwick, Warwick Med Sch, Clin Sci Res Labs, Univ Hosp, Coventry, W Midlands, England;Coventry Univ, Ctr Appl Biol & Exercise Sci, Fac Hlth & Life Sci, Coventry, W Midlands, England
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(creator_code:org_t)
- 2019-01-23
- 2019
- English.
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In: Neuroendocrinology. - : KARGER. - 0028-3835 .- 1423-0194. ; 108:4, s. 308-316
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Background/Aims: To evaluate the impact of lung metastases (LM) on overall survival (OS) in well-differentiated (WD) stage IV gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) patients along with developing surveillance strategies for thoracic imaging. Methods: Thirty-four patients with LM, from 3 centres, were identified (22 small intestine/12 pancreatic; 17 grade 1/15 grade 2/2 of unknown grade). For comparison, we used 106 stage IV WD, grade 1 and 2 GEP-NEN patients with metastatic disease confined in the abdomen. Results: LM prevalence was 4.9% (34/692). Eleven patients (32%) presented with synchronous LM whereas 23 (68%) developed metachronous LM at a median of 25 months (range 1-150 months). Patients with metachronous LM had already established liver and/or para-aortic lymph node metastases. Eighteen of 23 patients (78%) with metachronous LM exhibited concomitant progression in the abdomen. Median OS of WD GEP-NEN patients with LM was shorter than for those with stage IV disease without extra-abdominal metastases (56 [95% CI 40.6-71.6] vs. 122.7 [95% CI 70.7-174.8] months; log-rank p = 0.001). Among patients with progressive stage IV disease, the subset of patients with LM exhibited shorter OS (log-rank p = 0.005). LM were also confirmed as an independent prognostic factor for survival in multivariable analysis (HR 0.18; 95% CI 0.07-0.45; p< 0.0001). Conclusion: LM, although relatively rare in patients with WD stage IV GEP-NENs, may impact patients' outcome. The development of metachronous LM is associated with concomitant disease progression in established abdominal metastases in most patients. These patient-related parameters could be utilized for a stratified surveillance approach, mainly reserving thoracic imaging for GEP-NEN patients with progressive disease in the abdomen.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- Lung metastases
- Well-differentiated neoplasms
- Gastroenteropancreatic neuroendocrine neoplasms
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- art (subject category)
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Daskalakis, Kosm ...
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Tsoli, Marina
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Srirajaskanthan, ...
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Chatzellis, Elef ...
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Alexandraki, Kry ...
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Angelousi, Anna
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Pizanias, Michai ...
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Randeva, Harpal
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Kaltsas, Gregory
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Uppsala University