Outcomes of multidisciplinary treatment of neuroendocrine tumours of the small intestine
Keywords:
Intestinal Neoplasms, Carcinoma, Neuroendocrine, Small intestineAbstract
Aim: To describe the outcomes in a group of patients with neuroendocrine tumours (NETs) of the small intestine treated in a multidisciplinary group.
Methods: A descriptive study based on the clinical records of patients with confirmed histological diagnosis of a neuroendocrine tumour with intestinal primary between 1 May 2004 and 30 April 2014.
Results: A total of 301 patients diagnosed with NETs in different locations were treated during the study period, of which 48 cases of intestinal primary met the inclusion criteria. Surgery with curative or palliative intent was the first line of treatment in most patients (n = 35, 72.9%) and complete remission was achieved in 13 of them. Somatostatin analogues were the first line of management in 14.5%.
At the time of the last assessment, 13 patients (27.1%) remained disease-free, 17 patients (35.4%) with persistent but stable disease, and 7 patients (14.6%) had progressive disease. More than 50% of the patients remained alive at 55 months after diagnosis.
The higher age at diagnosis, the presence of carcinoid syndrome, the metastatic compromise, the histological grade, and elevated biochemical markers (Chromogranin A and 5-hydroxy indole acetic acid) were factors associated with a worse survival prognosis.
Conclusions: A summary is presented on the clinical outcomes of the treatment of patients with NET of primary intestinal by a multidisciplinary group, as well as the comparison of these outcomes with the data available in the literature.
Author Biographies
Luis Felipe Fierro-Maya, Instituto Nacional de Cancerología
Unidad de Endocrinología Oncológica, Instituto Nacional de Cancerología, Bogotá D. C, Colombia
Carolina Prieto, Hospital Pablo Tobón Uribe
Departamento de Endocrinología, Hospital Pablo Tobón Uribe, Medellín, Colombia
Gloria Garavito-G, Instituto Nacional de Cancerología
Instituto Nacional de Cancerología, Bogotá D. C, Colombia
Angélica María González-C, Universidad Nacional de Colombia
Departamento de Fisiología, Facultad de Medicina Universidad Nacional de Colombia, Bogotá D. C, Colombia
Yeinnyer Muleth, Instituto Nacional de Cancerología
Grupo Área de Investigaciones, Instituto Nacional de Cancerología, Bogotá D. C, Colombia
José Alexander Carreño, Instituto Nacional de Cancerología
Grupo Área de Investigaciones, Instituto Nacional de Cancerología, Bogotá D. C, Colombia
References
Pape UF, Perren A, Niederle B, Gross D, Gress T, Costa F, et al. ENETS Consensus Guidelines for the Management of Patients with Neuroendocrine Neoplasms from the Jejuno-Ileum and the Appendix Including Goblet Cell Carcinomas. Neuroendocrinology. 2012;95:135-56.
https://doi.org/10.1159/000335629
Ito T, Sasano H, Tanaka M, Osamura RY, Sasaki I, Kimura W, et al. Epidemiological study of gastroenteropancreatic neuroendocrine tumors in Japan. J Gastroenterol. 2010;45:234-43.
https://doi.org/10.1007/s00535-009-0194-8
Niederle MB, Hackl M, Kaserer K, Niederle B. Gastroenteropancreatic neuroendocrine tumours: the current incidence and staging based on the WHO and European Neuroendocrine Tumour Society classification: an analysis based on prospectively collected parameters. Endocr Relat Cancer. 2010;17:909-18.
https://doi.org/10.1677/ERC-10-0152
Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, et al. Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States. JAMA Oncol. 2017;3:1335-42.
https://doi.org/10.1001/jamaoncol.2017.0589
Hauso O, Gustafsson BI, Kidd M, Waldum HL, Drozdov I, Chan AK, et al. Neuroendocrine tumor epidemiology: contrasting Norway and North America. Cancer. 2008;113:2655-64.
https://doi.org/10.1002/cncr.23883
García-Carbonero R, Capdevila J, Crespo-Herrero G, Díaz-Pérez JA, Martínez del Prado MP, Alonso Ordu˜na V, et al. Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): Results from the National Cancer Registry of Spain (RGETNE). Ann Oncol. 2010;21:1794-803.
https://doi.org/10.1093/annonc/mdq022
Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, et al. One hundred years after ''carcinoid'': epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26:3063-72.
https://doi.org/10.1200/JCO.2007.15.4377
Hemminki K, Li X. Incidence trends and risk factors of carcinoid tumors: a nationwide epidemiologic study from Sweden. Cancer. 2001;92:2204-10.
https://doi.org/10.1002/1097-0142(20011015)92:8<2204::AID-CNCR1564>3.0.CO;2-R
Landerholm K, Falkmer S, Järhult J. Epidemiology of small bowel carcinoids in a defined population. World J Surg. 2010;34:1500-5.
https://doi.org/10.1007/s00268-010-0519-z
Curran T, Tulin-Silver S, Patel K, Ward S, Schneiderman M, Harpaz N, et al. Prognostic Clinicopathologic Factors in Longitudinally Followed Patients With Metastatic Small Bowel Carcinoid Tumors. Pancreas. 2011;40(8.).
https://doi.org/10.1097/MPA.0b013e318225483c
Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S. The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas. 2010;39:707-12.
https://doi.org/10.1097/MPA.0b013e3181ec124e
Rindi G, Klöppel G, Couvelard A, Komminoth P, Körner M, Lopes JM, et al. TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch. 2007;451:757-62.
https://doi.org/10.1007/s00428-007-0452-1
Bergestuen DS, Aabakken L, Holm K, Vatn M, Thiis- Evensen E. Small intestinal neuroendocrine tumors: Prognostic factors and survival. Scand J Gastroenterol. 2009;44: 1084-91.
https://doi.org/10.1080/00365520903082432
Hoej LB, Nykjær KM, Gronbaek H. Incidence and survival of patients with small intestinal neuroendocrine tumours in a Danish NET center. The Scientific World Journal. 2012;2012:206350.
https://doi.org/10.1100/2012/206350
Wu L, Fu J, Wan L, Pan J, Lai S, Zhong J, et al. Survival outcomes and surgical intervention of small intestinal neuroendocrine tumors: a population based retrospective study. Oncotarget. 2017;8:4935-47.
https://doi.org/10.18632/oncotarget.13632
Landerholm K, Zar N, Andersson RE, Falkmer SE, Järhult J. Survival and prognostic factors in patients with small bowel carcinoid tumour. Br J Surg. 2011;98:1617-24.
https://doi.org/10.1002/bjs.7649
Halperin DM, Shen C, Dasari A, Xu Y, Chu Y, Zhou S, et al. Frequency of carcinoid syndrome at neuroendocrine tumour diagnosis: a population-based study. Lancet Oncol. 2017;18:525-34.
https://doi.org/10.1016/S1470-2045(17)30110-9
Srirajaskanthan R, Ahmed A, Prachialias A, Srinivasan P, Heaton N, Jervis N, et al. ENETS TNM Staging Predicts Prognosis in Small Bowel Neuroendocrine Tumours. ISRN Oncol. 2013; 2013(Article ID 420795):7.
https://doi.org/10.1155/2013/420795
Kim MK, Warner RRP, Roayaie S, Harpaz N, Ward SC, Itzkowitz S, et al. Revised Staging Classification Improves Outcome Prediction for Small Intestinal Neuroendocrine Tumors. J Clin Oncol. 2013;31:3776-81.
https://doi.org/10.1200/JCO.2013.51.1477
Jann H, Roll S, Couvelard A, Hentic O, Pavel M, Müller-Nordhorn J, et al. Neuroendocrine tumors of midgut and hindgut origin: Tumor-node-metastasis classification determines clinical outcome. Cancer. 2011;117:3332-41.
https://doi.org/10.1002/cncr.25855
Norlén O, Stålberg P, Öberg K, Eriksson J, Hedberg J, Hessman O, et al. Long-Term Results of Surgery for Small Intestinal Neuroendocrine Tumors at a Tertiary Referral Center. World J Surg. 2012;36:1419-31.
https://doi.org/10.1007/s00268-011-1296-z
Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, et al. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med. 2017;376:125-35.
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