Prognostic factors influencing survival from metastatic (stage IV) gastroenteropancreatic well-differentiated endocrine carcinoma

Abstract

Survival of metastatic gastroenteropancreatic well-differentiated endocrine carcinoma (GEP WDEC) is not well characterized. We evaluated the long-term outcome and prognostic factors for survival in 118 patients with distant metastases from GEP WDEC. Inclusion criteria were 1) pathological review by a single pathologist according to the present WHO criteria, 2) absence of previous therapy apart from surgery, 3) complete morphological evaluation within 3 months including somatostatin receptor scintigraphy, and 4) follow-up at Gustave-Roussy Institute until death or study's end. Clinical, biological marker, and pathological parameters were analyzed in univariate and multivariate statistical models. Survival after the first complete imaging work-up of the metastatic disease was determined using Kaplan-Meier method. Overall, survival for 5 years after the diagnosis of metastatic disease was 54%. In multivariate analysis, age (hazard ratio (HR): 1.05, 95% confidence interval (CI): 1.01-1.08, PZ0.01), the number of liver metastases (HR: 3.4, 95% CI: 1.4-8.3, PZ0.01), tumor slope (HR: 1.1, 95% CI: 1.0-1.1, PZ0.001), and initial surgery (HR: 0.3, 95% CI: 0.1-0.8, PZ0.01) were predictive of survival. Five-year survival was 100%, 91% (95% CI, 51-98%), 62% (95% CI, 37-83%), and 9% (95% CI, 6-32%) when patients had 0, 1, 2, 3 or more poor prognostic features respectively. This study enables the stratification of metastatic GEP WDEC patients into distinct risk groups. These risk categories can be used to tailor therapeutic approaches and also to design and interpret clinical trials.

Are G3 ENETS neuroendocrine neoplasms heterogeneous?

“…For instance, the absence of midgut primaries and male predominance do not mirror classic metastatic low-grade well-differentiated GEP neoplasms in which ileum is the most frequent primary location and sex ratio is around one. This point is even better illustrated by the median OS of our patients, which is higher than the 8-month median OS usually observed in metastatic poorly differentiated NEC (Moertel et al 1991, Mitry et al 1999, Yamazaki et al 2005, Hainsworth et al 2006 but is still lower than expected for metastatic well-differentiated GEP-NEN, for which the 5-year survival is about 50% (Durante et al 2009.…”

Predictors of Long-Term Outcome in Patients with Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors After Peptide Receptor Radionuclide Therapy with 177Lu-Octreotate

“…However, because of the general lack of available prospective studies, potential predictors of outcome for patients with NET have been predominantly analyzed by use of retrospective data (16,35,36,38,(41)(42)(43)(44). The advantage of the present study is that our cohort of patients underwent the same treatment modality.…”

MGMT expression predicts response to temozolomide in pancreatic neuroendocrine tumors

“…Tumors were classified according to the 2010 WHO classification and the ENETS grading system (Rindi et al 2006). TEMbased regimens were proposed regardless of previous therapeutic line in case of progression of metastases according to Response Evaluation Criteria in Solid Tumors (RECIST) guidelines on two consecutive imaging procedures performed at 6-month intervals and/or when liver burden was >50% (Skinazi et al 1996, Durante et al 2009, Pavel et al 2012. Patients received TEM alone or in combination with capecitabine.…”