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Pancreas. 2014 Mar;43(2):212-8. doi: 10.1097/MPA.0000000000000032.

Advanced digestive neuroendocrine tumors: metastatic pattern is an independent factor affecting clinical outcome.

Author information

1
From the *Digestive and Liver Disease, Sapienza University of Rome, Sant'Andrea Hospital, Rome; †Dept of Surgery, Pancreatic Surgery Unit, Università Politecnica delle Marche, Ancona; ‡Ospedale Sacro Cuore Don Calabria, Negrar; §Department of Clinical Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna; ∥Radiology, ¶Pathology Unit, and #Surgery 1, Sapienza University of Rome, Sant'Andrea Hospital, Rome; **ARC-NET Center for Applied Research on Cancer and Department of Pathology and Diagnostics, University of Verona, Verona; and ††Medical Oncology, Università Politecnica delle Marche, Ancona, Italy.

Abstract

OBJECTIVES:

The objective of this study was to determine the impact of different metastatic spread patterns on outcome in advanced digestive neuroendocrine tumors (NETs).

METHODS:

This was a retrospective analysis of patients with stage IV NETs, classified as group 1 (unilobar liver metastases), group 2 (bilobar liver metastases), group 3 (extra-abdominal metastases). End points were overall survival (OS) and progression-free survival (PFS). Risk factor analysis was performed using Cox proportional hazard model.

RESULTS:

Of the 229 patients, 135 (58.9%) had pancreatic, and 94 (41.1%) small bowel NETs: 32 (13.9%) were included in group 1, 179 (78.2%) in group 2, and 18 (7.9%) in group 3. Median Ki67 was 4.5%. Overall, 5-year OS was 55%. Different OS was observed among the 3 groups: median survival not reached, 81 and 8 months, respectively (P < 0.001). Median PFS was 18 months. Both OS and PFS were significantly affected by Ki67 and metastatic spread pattern.

CONCLUSIONS:

The stratification of stage IV NET patients based on metastatic patterns, alongside Ki67, predicts the clinical outcome. The extent of metastatic disease is a previously unrecognized variable, which should be considered when evaluating the results of treatments in NET patients with advanced disease.

PMID:
24518498
DOI:
10.1097/MPA.0000000000000032
[Indexed for MEDLINE]

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