Comparison of survival between malignant neuroendocrine tumours of midgut and pancreatic origin

Abstract

Neuroendocrine tumours of the gastrointestinal tract are rare diseases and with the presence of metastases, patients may suffer from disabling symptoms of hormone overproduction. Potentially curative surgery can be performed in patients with localized disease, and sometimes in patients with liver metastases. However, long-term follow-up of the latter patients mostly shows late tumour recurrences (Norton, 1994). Debulking (cytoreductive) surgery can be considered when most of the tumour burden can be excised safely to minimize hormonal symptoms and to facilitate medical therapy (McEntee et al, 1990;Carty et al, 1992;Que et al, 1995). An important question is whether the aggressive treatment of metastatic disease prolongs survival. No randomized studies are available today. Such studies are complicated by the lack of strict surgical treatment protocols running over long periods, the relatively low number of patients and the absence of a TNM (tumour, node, metastases) classification of these tumour types. Many clinical studies, in which debulking surgery and resection rates are discussed, are composed of patients with carcinoids and those with endocrine pancreatic tumours (EPT). However, these two disease entities may include tumours with markedly different biology.In our consecutive series of patients with advanced midgut carcinoids (all with locoregional and hepatic metastases) the estimated overall 5-year survival was 69% after active interventional treatment. The 5-year survival of carcinoid patients with bilobar liver metastases was 63% (cf. Wängberg et al, 1996). These figures are superior to the ones obtained after more conservative treatment. In a consecutive series of 42 patients with metastatic EPT from National Institutes of Health, the 5-year survival of those 17 patients resected for cure was 79% versus 28% in the non-resected group (Carty et al, 1992). Similar results were recently reported from the Mayo Clinic in 74 patients with hepatic metastases from either EPT or carcinoid tumours. The 4-year survival was 85% for one-third of the patients selected for resection versus 65% for the two-thirds non-resected (Que et al, 1995). In a recent French series of 34 patients with neuroendocrine tumours (carcinoids and EPT) and hepatic metastases, the liver resection rate was as high as 50%. Twelve of these 17 patients were operated upon with curative intent (Dousset et al, 1996).The aim of this retrospective study was to compare survival in our consecutive series of patients with malignant EPT with that of patients with advanced midgut carcinoids when subjected to similar treatment principles. Furthermore, EPT were staged according to the TNM classification of pancreatic carcinoma. By doing so, stage IV tumours should be compared with advanced carcinoid tumours with liver metastases.  Patients and treatmentThe 64 consecutive patients with advanced midgut carcinoids were treated during 1987-1997 (cf. Wängberg et al, 1996. All patients underwent primary surgery, removal of the primary tumo...

Establishing the Quantitative Relationship Between Lanreotide Autogel®, Chromogranin A, and Progression-Free Survival in Patients with Nonfunctioning Gastroenteropancreatic Neuroendocrine Tumors

“…The other two predictors of PFS were hepatic tumor load >25% at baseline and primary tumor located in the pancreas. These results are consistent with previous knowledge, which correlate hepatic tumor load and pancreatic tumors with worse prognosis in GEP-NETs (3,9,11,16,18,36).…”

“…To date, the most significant prognostic factors identified for GEPNETs include the size of the primary tumor (1,2) with worse prognosis for pancreatic tumors (9,11,16), presence of metastasis (1,2,5,9), proliferative index (2,17), high hepatic tumor load (3,11,18,19), and CgA expression (3,11,13). It has been suggested that CgA levels are a predictive factor for outcome.…”

Perspectives on Surgical Management of Neuroendocrine Liver Metastases

“…NETs have been grouped into well-differentiated (grade 1), moderately differentiated (grade 2) and poorly differentiated (grade 3) [15]. The 5-year survival for grade 1 NETs is 96%, grade 2 NETs 73% and grade 3 NETs 28% [4,[15][16][17][18][19][20].…”

Interventional Treatment of Gastrointestinal Neuroendocrine Tumours

“…The similarities between treatment results indicate that EPT tumours are more aggressive than MC tumours. (Reproduced by permission of Br J Cancer [55]). …”

“…This is not an easy task, since a 5-year survival of 70% can be achieved in patients with midgut carcinoids and liver metastases using multimodal therapy and a 10-year survival well exceeding 50% (fig. 2) [55]. The following indications for liver transplantation in patients with NE tumours may be considered:…”