Poorly differentiated gastro-entero-pancreatic neuroendocrine carcinomas: Are they really heterogeneous? Insights from the FFCD-GTE national cohort.

Autor: Walter T; University Hospital, Lyon, France. Electronic address: thomas.walter@chu-lyon.fr., Tougeron D; University Hospital, Poitiers, France., Baudin E; Gustave Roussy Institute, Villejuif, France., Le Malicot K; FFCD, Dijon, France., Lecomte T; Trousseau Hospital, Tours, France., Malka D; Gustave Roussy Institute, Villejuif, France., Hentic O; Beaujon Hospital, Clichy, France., Manfredi S; University Hospital, Rennes, France., Bonnet I; Valenciennes Hospital, Valenciennes, France., Guimbaud R; University Hospital, Toulouse, France., Coriat R; Cochin Hospital, University Paris Descartes, Paris, France., Lepère C; Georges Pompidou European Hospital, University Paris-V, Paris, France., Desauw C; University Hospital, Lille, France., Thirot-Bidault A; Hôpitalde Bicêtre, Le Kremlin Bicêtre, France., Dahan L; La Timone Hospital, Marseille, France., Roquin G; University Hospital, Angers, France., Aparicio T; Avicenne Hospital, Bobigny, France., Legoux JL; Hôpital de la Source, Orléans, France., Lombard-Bohas C; University Hospital, Lyon, France., Scoazec JY; Gustave Roussy Institute, Villejuif, France., Lepage C; FFCD, Dijon, France; University Hospital, Dijon, France., Cadiot G; University Hospital, Reims, France.
Jazyk: angličtina
Zdroj: European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2017 Jul; Vol. 79, pp. 158-165. Date of Electronic Publication: 2017 May 11.
DOI: 10.1016/j.ejca.2017.04.009
Abstrakt: Background: Diagnosis and management of poorly differentiated gastro-entero-pancreatic (GEP) neuroendocrine carcinomas (NECs) remain challenging. Recent studies suggest prognostic heterogeneity. We designed within the French Group of Endocrine Tumours a prospective cohort to gain insight in the prognostic stratification and treatment of GEP-NEC.
Patients and Methods: All patients with a diagnosis of GEP-NEC between 1st January 2010 and 31st December 2013 could be included in this national cohort. Adenoneuroendocrine tumours were excluded.
Results: 253 patients from 49 centres were included. Median age was 66 years. Main primary locations were pancreas (21%), colorectal (27%), oesophagus-stomach (18%); primary location was unknown in 20%. Tumours were metastatic at diagnosis in 78% of cases. Performance status (PS) at diagnosis was 0-1 in 79% of patients. Among the 147 (58%) cases reviewed by an expert pathological network, 39% were classified as small cell NEC and 61% as large cell NEC. Median Ki67 index was 75% (range, 20-100). Median overall survival was 15.6 (13.6-17.0) months. Significant adverse prognostic factors in univariate analysis were PS > 1 (hazard ratio [HR] = 2.5), metastatic disease (HR = 1.6), NSE>2 upper limit of normal [ULN]; HR = 3.2), CgA>2 ULN (HR = 1.7) and lactate dehydrogenase >2 ULN (HR = 2.1). After first-line palliative chemotherapy (CT1) with platinum-etoposide (n = 152), objective response, progression-free survival and overall survival were 50%, 6.2 and 11.6 months; they were 24%, 2.9 and 5.9, respectively, after post-CT1 FOLFIRI regimen (n = 72).
Conclusions: We report a large prospective series of GEP-NEC which show the predominance of large cell type and advanced stage at diagnosis. Prognosis was found more homogeneous than previously reported, mainly impacted by PS and tumour burden.
(Copyright © 2017 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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