Prognostic Factors across Poorly Differentiated Neuroendocrine Neoplasms: A Pooled Analysis

Abstract

Introduction: Poorly differentiated neuroendocrine carcinomas (NECs) are characterized by aggressive clinical course and poor prognosis. No reliable prognostic markers have been validated to date; thus, the definition of a specific NEC prognostic algorithm represents a clinical need. This study aimed to analyze a large NEC case series to validate the specific prognostic factors identified in previous studies on gastro-entero-pancreatic (GEP) and lung NECs and to assess if further prognostic parameters can be isolated. Methods: A pooled analysis of four NEC retrospective studies was performed to evaluate: the prognostic role of Ki-67 cut-off, the OS according to primary cancer site, and further prognostic parameters using multivariable Cox proportional hazards model and machine-learning random survival forest (RSF). Results: 422 NECs were analyzed. The most represented tumor site was the colorectum (n=156, 37%), followed by the lungs (n=111, 26%), gastroesophageal site (n=83, 20%; 66 gastric, 79%). The Ki-67 index was the most relevant predictor, followed by morphology (pure or mixed/combined NECs), stage, and site. The predicted RSF response for survival at 1, 2, or 3 years showed decreasing survival with increasing Ki-67, pure NEC morphology, stage III–IV, and colorectal NEC disease. Patients with Ki-67 <55% and mixed/combined morphology had better survival than those with pure morphology. Morphology pure or mixed/combined became irrelevant in NECs survival when Ki-67 was ≥55%. The prognosis of metastatic patients who did not receive any treatment tended to be worse compared to that of the treated group. The prognostic impact of Rb1 immunolabeling appears to be limited when multiple risk factors are simultaneously assessed. Conclusion: The most effective parameters to predict OS for NEC patients could be Ki-67, pure or mixed/combined morphology, stage, and site.

The association between jaundice and poorly differentiated pancreatic neuroendocrine neoplasms (Ki67 index > 55.0%)

“…In the present study we chose 55% as a cut-off value for poorly differentiated PNEN. Some studies have shown that PNEN patients with a Ki-67 < 55% had a better prognosis [ 12 , 26 ]. Milione et al also showed that the Ki-67 index cutoff at 55% was a powerful predictor of over survival in patients with bronchopulmonary pure and composite large cell neuroendocrine carcinomas [ 27 ].…”

Towards Understanding the Survival of Patients with High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms: An Investigation of Ensemble Feature Selection in the Prediction of Overall Survival

“…Previous research on GEP NEN shows that some features impact the survival of patients; those are Age at diagnosis, WHO performance status, Primary tumor location, Tumor morphology, Tumor differentiation, Lactate dehydrogenase (LDH), Platelets, Albumin, Ki-67, SUV max , and TNM-staging [5,[8][9][10][11][12][13][14]. Tumor differentiation is highly correlated to tumor morphology, so we do not include the feature in this work.…”

“…The prognosis for patients with advanced GEP NEC is poor, with a median survival of less than 12 months [5,6], whilst the prognosis for locoregional GEP NEC is higher; 20.7 months [7]. Numerous recently published studies [5,[8][9][10][11][12][13][14] have shown the prognostic importance of several parameters on overall survival (OS) such as age, performance status (PS), primary tumor site, tumor differentiation, TNM-stage, serum lactate dehydrogenase (LDH), serum platelet levels, proliferation marker Ki-67, maximum standardized uptake value (SUV max ), total metabolic tumor volume (tMTV) and total total lesion glycolysis (tTLG). Establishing more robust prognostic parameters and validating established parameters is essential to provide optimal care for this patient group.…”