The prognosis and management of neuroendocrine neoplasms-related metastatic bone disease: lessons from clinical practice
| Autor: | Simona Grozinsky-Glasberg, Inbal Uri, Olu Adesanya, David J. Gross, Marina Tsoli, Tristan Page, Rajaventhan Srirajaskanthan, Harpal S. Randeva, Krystallenia I Alexandraki, Denise Kolomodi, Chen Sheng Low, Dimitrios Thomas, Gregory Kaltsas, Martin O. Weickert, Michail Pizanias |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Multivariate analysis Bone disease Endocrinology Diabetes and Metabolism Bone Neoplasms 030209 endocrinology & metabolism Young Adult 03 medical and health sciences 0302 clinical medicine Endocrinology Stable Disease Internal medicine Diabetes mellitus Intestinal Neoplasms medicine Humans Aged Aged 80 and over Diphosphonates business.industry Disease Management Middle Aged Prognosis medicine.disease Optimal management Pancreatic Neoplasms Clinical Practice Neuroendocrine Tumors medicine.anatomical_structure Denosumab 030220 oncology & carcinogenesis Female Tomography X-Ray Computed Pancreas business medicine.drug |
| Zdroj: | Endocrine. 64:690-701 |
| ISSN: | 1559-0100 1355-008X |
| Popis: | To study the evolution and optimal management of metastatic bone disease (mBD) in patients with neuroendocrine neoplasms (NENs). Seventy-four patients were recruited from four NEN centers in this observational multicenter study. Pancreas and small bowel were the most common primaries (30 and 27%, respectively). Almost all gastrointestinal (GI)-NENs were grades 1 and 2, whereas bronchopulmonary-thymic were atypical carcinoids. Thirty-two (43%) patients had synchronous metastatic bone disease (mBD) and three patients reported bone-specific symptoms; metachronous mBD developed at a median of 35 (range: 4–395) months. Thirty-six (86%) of patients with metachronous mBD had stage IV disease at diagnosis. Somatostatin receptor functional imaging and computed tomography were the modalities mostly used for mBD identification. Fifty-two patients received assessable bone-related therapy (bisphosphonates, denosumab, local radiotherapy, and radionuclide treatment). Improvement in mBD was seen in 5, stable disease in 22, and deterioration in 25 patients. The presence of synchronous mBD and the negative outcome of bone-related therapy negatively affected overall survival (OS). In the multivariate analysis, the stronger predictor of OS was the outcome of bone-related therapy (HR: 4.753; 95% CI: 1.589–14.213). Bisphosphonates therapy was the mostly used bone-specific treatment but its monthly administration did not affect OS. At last follow-up, 39 patients were alive with OS 50 (14–463) months. Early investigation for mBD offers a prognostic marker of patients with NENs, since synchronous mBD has a negative impact on survival. The outcome of bone-related therapy affects OS but the monthly administration of bisphosphonates did not show a benefit over less intense schemes. |
| Databáze: | OpenAIRE |
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