Prognostic factors in patients with endocrine tumours of the duodenopancreatic area

Madeira, I.; Terris, Benoı̂t; Voss, Martina; Denys, Alban; Sauvanet, Alain; Fléjou, Jean‐François; Vilgrain, Valérie; Belghiti, Jacques; Bernadès, P; Ruszniewski, Philippe

doi:10.1136/gut.43.3.422

Cited by 229 publications

(177 citation statements)

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“…Five-year OS for patients with metastatic NETs has been reported ranging from 26 to 73% in previous large series, showing a rather variable survival that needs to be further stratified (Eriksson et al, 1990;Madeira et al, 1998;Hochwald et al, 2002;Modlin et al, 2003).…”

Section: Discussionmentioning

confidence: 95%

“…In a study by Madeira et al (1998) including NETs from the duodenopancreatic area and excluding carcinoids, PDNECs in patients presenting with liver metastases were associated with an HR for death of 8.11 (multivariate analysis). The rates of WDNECs and PDNECs were comparable to those observed in our study (WDNECs 78%, PDNECs 11%, nonevaluated 11%).…”

Section: Discussionmentioning

confidence: 99%

“…Radiological degree of liver involvement in NETs is a welldocumented prognostic factor (Janson et al, 1997;Madeira et al, 1998;Kouvaraki et al, 2004). Number of liver metastases (more than four) and proportion of liver volume involved (more than 75%) have been shown to correlate with poorer OS (Janson et al, 1997;Kouvaraki et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

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The prognostic role of WHO classification, urinary 5-hydroxyindoleacetic acid and liver function tests in metastatic neuroendocrine carcinomas of the gastroenteropancreatic tract

et al. 2007

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The World Health Organisation (WHO) classification (2000) is widely used to classify neuroendocrine carcinomas (NECs), yet its prognostic value needs to be confirmed. In this study, patients with metastatic NECs (n ¼ 119) were classified according to WHO guidelines into well differentiated and poorly differentiated (WDNECs and PDNECs). Histological differentiation based on WHO criteria had the highest impact on overall survival (OS) (PDNECs : WDNECs hazard ratio (HR) ¼ 4.02, P ¼ 0.02); however, PDNECs represented only a small percentage of patients (8%). In a WDNEC-restricted analysis, abnormal liver function tests (LFTs) and elevated urinary 5-hydroxyindoleacetic acid (u5HIAA) were independent prognostic factors for survival (HR ¼ 2.65, P ¼ 0.006 and HR ¼ 2.51, P ¼ 0.003, respectively) and were used to create a WDNEC-specific prognostic model (low risk ¼ both normal, intermediate risk ¼ one of them abnormal, high risk ¼ both abnormal). Low-risk WDNECs had the most favourable prognosis (median OS, mOS 8.1 years), which was significantly better compared to both intermediate-risk and high-risk WDNECs (mOS 3.2 and 1.4 years, with P ¼ 0.01 and Po0.001, respectively). High-risk WDNECs displayed the shortest OS (1.3 years), which was similar to that of PDNECs (P ¼ 0.572). This analysis supports the prognostic value of WHO classification for metastatic NECs arising from the gastroenteropancreatic tract; however, risk stratification using readily available u5HIAA and LFTs may be necessary for the heterogeneous group of WDNECs.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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The prognostic role of WHO classification, urinary 5-hydroxyindoleacetic acid and liver function tests in metastatic neuroendocrine carcinomas of the gastroenteropancreatic tract

et al. 2007

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“…This must be discussed knowing half of the patients with extra-hepatic lesions had exclusively an unresected primary lesion or abdominal metastatic lymph nodes, and the others had a limited number of small lesions. The major prognostic role of liver metastases prompted TACE in these patients (Madeira et al, 1998;Gullo et al, 2003;Modlin et al, 2003;Plockinger et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

“…Their prognosis is usually considered as being favourable because of their slow-growing pattern, even though this needs to be discussed according to several factors affecting patients' survival. Among these, the presence of liver metastases is one of the most important (Madeira et al, 1998;Gullo et al, 2003;Modlin et al, 2003;Plockinger et al, 2004). First-line treatment is then surgery, as it is the only treatment that allows a definite cure.…”

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confidence: 99%

Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours

et al. 2006

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Transcatheter arterial chemoembolisation (TACE) has been reported to be an efficient treatment of liver metastases of endocrine tumours in short series of patients. However, several factors seem to affect its results. The aim of this work is to identify predictors of response to TACE for liver metastases of endocrine tumours. A total of 163 TACE procedures were performed in 67 patients between 1994 and 2004. Forty-four patients were treated with streptozotocin and 23 with doxorubicin. Primary tumour was located in the pancreas for 19 patients, and had been removed in 43. Thirty-eight tumours were functioning. Response rate was 37% (confidence interval [CI] 95%: 28 -49%). Median time to progression (TTP) was 14.5 months (CI 95%: 9 -41). In multivariate analysis (n ¼ 43), predictors of tumour response were body mass index (BMI) (odds ratio [OR]: 1.3; CI 95%: 1.04 -1.63; P ¼ 0.022), functioning type of tumour (OR: 7.31; CI 95%: 1.26 -42.5; P ¼ 0.027), arterial phase enhancement on abdominal computed tomography (CT) (OR: 8.11; CI 95%:1.06 -62; P ¼ 0.044) and use of streptozotocin for cytotoxic agent (OR: 21.3; CI 95%: 1.48 -306; P ¼ 0.025). Analysis of TTP predictors showed that BMI (hazard ratio [HR]: 0.85; CI 95%: 0.76 -0.86; P ¼ 0.01) and arterial phase enhancement (HR: 0.3; CI 95%: 0.12 -0.73; P ¼ 0.008) were associated with delayed progression. This large study confirms the previously reported results of TACE regarding its efficacy for the treatment of liver metastases of endocrine tumours. Arterial phase enhancement on abdominal CT and BMI are predictors of treatment's efficacy. Streptozotocin should be the preferred cytotoxic agent in order to save anthracycline for systemic chemotherapy.

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Pancreatic Endocrine Tumors With Major Vascular Abutment, Involvement, or Encasement and Indication for Resection

Norton

Harris²,

Chen³

et al. 2011

Arch Surg

106

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Prognostic factors in patients with endocrine tumours of the duodenopancreatic area

Abstract: Progression of liver metastases is also an important factor which must be taken into account when deciding on the therapeutic approach. The only other independent prognostic factors are tumoral cell diVerentiation and complete resection of the primary tumour. (Gut 1998;43:422-427)

Cited by 229 publications

References 15 publications

The prognostic role of WHO classification, urinary 5-hydroxyindoleacetic acid and liver function tests in metastatic neuroendocrine carcinomas of the gastroenteropancreatic tract

The prognostic role of WHO classification, urinary 5-hydroxyindoleacetic acid and liver function tests in metastatic neuroendocrine carcinomas of the gastroenteropancreatic tract

Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours

Pancreatic Endocrine Tumors With Major Vascular Abutment, Involvement, or Encasement and Indication for Resection

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