Department of Oncology, Haukeland University Hospital, Bergen, Norway.
Ann Oncol. 2013 Jan;24(1):152-60. doi: 10.1093/annonc/mds276. Epub 2012 Sep 11.
As studies on gastrointestinal neuroendocrine carcinoma (WHO G3) (GI-NEC) are limited, we reviewed clinical data to identify predictive and prognostic markers for advanced GI-NEC patients.
Data from advanced GI-NEC patients diagnosed 2000-2009 were retrospectively registered at 12 Nordic hospitals.
The median survival was 11 months in 252 patients given palliative chemotherapy and 1 month in 53 patients receiving best supportive care (BSC) only. The response rate to first-line chemotherapy was 31% and 33% had stable disease. Ki-67<55% was by receiver operating characteristic analysis the best cut-off value concerning correlation to the response rate. Patients with Ki-67<55% had a lower response rate (15% versus 42%, P<0.001), but better survival than patients with Ki-67≥55% (14 versus 10 months, P<0.001). Platinum schedule did not affect the response rate or survival. The most important negative prognostic factors for survival were poor performance status (PS), primary colorectal tumors and elevated platelets or lactate dehydrogenase (LDH) levels.
Advanced GI-NEC patients should be considered for chemotherapy treatment without delay.PS, colorectal primary and elevated platelets and LDH levels were prognostic factors for survival. Patients with Ki-67<55% were less responsive to platinum-based chemotherapy, but had a longer survival. Our data indicate that it may not be correct to consider all GI-NEC as one single disease entity.
由于对胃肠道神经内分泌癌（WHO G3）（GI-NEC）的研究有限，我们回顾了临床数据，以确定晚期 GI-NEC 患者的预测和预后标志物。
2000-2009 年在 12 家北欧医院诊断为晚期 GI-NEC 的患者的数据进行了回顾性登记。
252 例接受姑息化疗的患者中位生存期为 11 个月，53 例仅接受最佳支持治疗（BSC）的患者中位生存期为 1 个月。一线化疗的缓解率为 31%，33%的患者疾病稳定。Ki-67<55%是通过接收者操作特征分析得出的与缓解率相关的最佳截断值。Ki-67<55%的患者缓解率较低（15%对 42%，P<0.001），但生存时间优于 Ki-67≥55%的患者（14 对 10 个月，P<0.001）。铂类方案对缓解率和生存率均无影响。对生存最重要的负预后因素是较差的表现状态（PS）、结直肠原发肿瘤以及血小板和乳酸脱氢酶（LDH）水平升高。
晚期 GI-NEC 患者应考虑尽快进行化疗。PS、结直肠原发肿瘤以及血小板和 LDH 水平升高是生存的预后因素。Ki-67<55%的患者对铂类化疗的反应性较低，但生存时间较长。我们的数据表明，将所有 GI-NEC 视为单一疾病实体可能并不正确。
