Pathological Incidence of Duodenopancreatic Neuroendocrine Tumors in The Netherlands

Kuiper, Patricia; Verspaget, Hein W.; Slooten, Henk-Jan van; Overbeek, L.I.H.; Biemond, I.; Lamers, C. B. H. W.

doi:10.1097/mpa.0b013e3181f3a681

Cited by 10 publications

(9 citation statements)

References 16 publications

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“…This effect, which has been also reported in other series [7,16,17,18,19,20,33], is expected to be ameliorated over time as imaging and other diagnostic techniques continue to improve. Consistent with this is the observation by some registries of a steady increase in the incidence of NF but not of F-PNENs [4]. However, NF-PNENs were also associated with a higher incidence of histological features denoting more aggressive disease, such as poor tumor differentiation, Ki-67 >20% or vascular invasion, among others.…”

Section: Discussionsupporting

confidence: 72%

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Prognostic Factors and Long-Term Outcome of Pancreatic Neuroendocrine Neoplasms: Ki-67 Index Shows a Greater Impact on Survival than Disease Stage. The Large Experience of the Spanish National Tumor Registry (RGETNE)

Martín-Pérez

Capdevila²,

Castellano³

et al. 2013

Neuroendocrinology

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Introduction: Pancreatic neuroendocrine neoplasms (PNENs) are uncommon neoplasms with a wide spectrum of clinical behavior. The objective of this study was to assess in a large cohort of patients the relative impact of prognostic factors on survival. Methods: From June 2001 through October 2010, 1,271 patients were prospectively registered online (www.getne.org) at the Spanish National Cancer Registry for Gastroenteropancreatic Neuroendocrine Tumors (RGETNE) by participating centers. Clinical and histopathological features were assessed as potential prognostic factors by uni- and multivariate analyses. Results: Of 483 PNENs, 171 (35%) were functional (F) and 312 (65%) non-functional (NF). NF-PNENs were associated with a higher incidence of histological features denoting more aggressive disease, such as poor tumor differentiation, Ki-67 >20%, or vascular invasion (NF- vs. F-PNENs, respectively, p < 0.05). Nevertheless, functionality was not a significant predictor of survival (p = 0.19). Stage at diagnosis, Ki-67 index, tumor differentiation and surgical resection of the primary tumor were all significant prognostic factors in univariate analysis. However, Ki-67 (>20 vs. ≤2%) (hazard ratio (HR) 2.21, p = 0.01) and surgical resection (yes vs. no) (HR 0.92, p = 0.001) were the only independent predictors of survival in multivariate analysis. Among patients who underwent surgery, high Ki-67 index (HR 10.37, p = 0.02) and poor differentiation (HR 8.16, p = 0.03) were the only independent predictors of clinical outcome. Conclusion: Ki-67 index and tumor differentiation are key prognostic factors influencing survival of patients with PNENs and, in contrast to what it is observed for other solid malignancies, they seem to have a greater impact on survival than the extent of disease. This should be borne in mind by physicians in order to appropriately tailor therapeutic strategies and surveillance of these patients.

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Section: Discussionsupporting

confidence: 72%

“…Their incidence has substantially increased, particularly of non-functional tumors [4], probably due to improved diagnostic techniques and clinical awareness. The recent development of new effective anticancer agents in this context has likely contributed to it too.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors and Long-Term Outcome of Pancreatic Neuroendocrine Neoplasms: Ki-67 Index Shows a Greater Impact on Survival than Disease Stage. The Large Experience of the Spanish National Tumor Registry (RGETNE)

Martín-Pérez

Capdevila²,

Castellano³

et al. 2013

Neuroendocrinology

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“…Thus, complaints associated with major depressive disorders, somatoform disorders or chronic fatigue syndrome are not likely caused by any chronic form of Lyme disease, irrespective of seropositivity of Borrelia IgG. Not the complaints and seropositivity per se but only the presence of objective symptoms of chronic Lyme disease (PCR methods that detect Borrelia burgdorferi DNA, positive findings in the cerebrospinal fluid (24)) should lead to additional interventions with antibiotics in suspected chronic Lyme disease.…”

Section: Discussionmentioning

confidence: 94%

No association of seropositivity for anti-Borrelia IgG antibody with mental and physical complaints

Grabe¹,

Spitzer²,

Lüdemann³

et al. 2008

Nordic Journal of Psychiatry

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Undiagnosed chronic Lyme disease caused by Borrelia burgdorferi is considered a differential diagnoses in medically unexplained symptoms like arthralgias, distal paresthesias, depressive symptoms, lack of concentration and fatigue. The aims of the study were to assess the association of mental and physical complaints with seropositivity for anti-Borrelia IgG in a general population sample. Seropositivity indicated an infection with Borrelia in the past. The Study of Health in Pomerania was conducted in a community living in a region with endemic Lyme disease. Mental and physical complaints were assessed on 38 items with the von Zerssen's complaint scale. IgG antibodies to Borrelia were determined by ELISA in 4264 individuals. Seropositivity was analyzed applying two cut-off scores (>5 and >10 IU/ml). IgG antibodies to Borrelia were found positive in 388 subjects (9.1%) applying the >5 IU/ml cut-off and in 130 subjects (3.0%) applying the >10 IU/ml cut-off. In multivariate analyses (MANCOVA), both definitions of seropositivity were not associated with increased mental or physical complaints while adjusting for gender, age, employment status, rural residency, physical activity, diabetes mellitus and number of chronic diseases. In the general population, seropositivity for anti-Borrelia IgG antibodies was not associated with an increase of self-rated mental or physical complaints or impairments. Therefore, clinicians should not overvalue seropositivity for anti-Borrelia IgG as a medical cause for unexplained mental or physical complaints.

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“…Because neuroendocrine cells are present in almost every organ, a primary NET can likewise arise in almost any tissue. Despite their lineage, most NETs do not secrete hormones (2), such that the particular symptoms caused by a given NET are often unspecific, such as abdominal discomfort arising from mass effects. Even typical endocrine symptoms of NET such as diarrhea or flushing are by no means NET-specific.…”

mentioning

confidence: 99%

The Role of ⁶⁸Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors

Haug

Cindea-Drimus

Auernhammer³

et al. 2012

J Nucl Med

147

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In patients with suspected but yet not localized neuroendocrine tumors (NETs), early diagnosis or reliable exclusion is crucial for optimal individual prognosis and therapy. Despite recourse to several imaging modalities, the definite diagnosis of NET can be challenging. Therefore, we tested 68 Ga-DOTATATE PET/CT as a tool for improved diagnosis in a cohort of patients with suspected, nonlocalized NET. Methods: 68 Ga-DOTATATE PET/CT recordings were obtained in 104 consecutive patients meeting at least one of the following criteria: clinical suspicion of NET (n 5 70), elevated blood levels of tumor markers (n 5 49), and image-based suspicion of NET (n 5 53). The presence of NET was validated by histopathology (n 5 49) or clinical follow-up of 107 6 59 wk (n 5 55). Results: In 36 of 104 patients (35%), NET was histologically verified, most frequently located in the small bowel (10/36), pancreas (8/36), lung (5/36), and stomach (2/36). Twelve patients had tumors of nonneuroendocrine origin, and 7 patients had benign tumors. 68 Ga-DOTATATE PET/CT identified NET in 29 of the 36 cases and excluded the presence of a NET in 61 of the 68 non-NET patients, indicating a sensitivity of 81% and specificity of 90%. The PET/CT gave a false-positive result in 7 patients and a false-negative in another 7 patients, indicating positive and negative predictive values of 81% and 90%, respectively, and an accuracy of 87%. Chromogranin A levels were significantly higher in both PET-positive patients (1,841 vs. 342 ng/mL; P , 0.05) and patients with verified NET (2,214 vs. 524 ng/mL; P , 0.05). Conclusion: In patients with suspected NETs due to clinical symptoms, elevated levels of tumor markers, or indeterminate tumors suggestive of NET, 68 Ga-DOTATATE PET/CT is highly accurate, thus supporting its use in clinical routine diagnostics.

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Pathological Incidence of Duodenopancreatic Neuroendocrine Tumors in The Netherlands

Abstract: The incidence of duodenopancreatic nonfunctional neuroendocrine tumors in The Netherlands increased over 1991 to 2009. The etiology for this change includes improved diagnostic techniques and clinical awareness, as discussed.

Cited by 10 publications

References 16 publications

Prognostic Factors and Long-Term Outcome of Pancreatic Neuroendocrine Neoplasms: Ki-67 Index Shows a Greater Impact on Survival than Disease Stage. The Large Experience of the Spanish National Tumor Registry (RGETNE)

Prognostic Factors and Long-Term Outcome of Pancreatic Neuroendocrine Neoplasms: Ki-67 Index Shows a Greater Impact on Survival than Disease Stage. The Large Experience of the Spanish National Tumor Registry (RGETNE)

No association of seropositivity for anti-Borrelia IgG antibody with mental and physical complaints

The Role of ⁶⁸Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors

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Pathological Incidence of Duodenopancreatic Neuroendocrine Tumors in The Netherlands

Abstract: The incidence of duodenopancreatic nonfunctional neuroendocrine tumors in The Netherlands increased over 1991 to 2009. The etiology for this change includes improved diagnostic techniques and clinical awareness, as discussed.

Cited by 10 publications

References 16 publications

Prognostic Factors and Long-Term Outcome of Pancreatic Neuroendocrine Neoplasms: Ki-67 Index Shows a Greater Impact on Survival than Disease Stage. The Large Experience of the Spanish National Tumor Registry (RGETNE)

Prognostic Factors and Long-Term Outcome of Pancreatic Neuroendocrine Neoplasms: Ki-67 Index Shows a Greater Impact on Survival than Disease Stage. The Large Experience of the Spanish National Tumor Registry (RGETNE)

No association of seropositivity for anti-Borrelia IgG antibody with mental and physical complaints

The Role of 68Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors

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The Role of ⁶⁸Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors