Vítek P, Strenková J, Sedláčková E, Barkmanová J, Mužík J, Louthan O
Kooperativní skupina pro neuroendokrinní nádory o. s., Praha.
Klin Onkol. 2013;26(4):271-80. doi: 10.14735/amko2013271.
Neuroendocrine tumors are traditionally considered to be "rare" diseases. On contrary, the prevalence of neuroendocrine tumors is high. Therefore, the diagnostics, treatment and follow-up of neuroendocrine tumors are subjected to an evolving interest. There are various specifics of neuroendocrine tumors requiring an appropriate feedback of each intervention i.e. data collection and central data evaluation. The "Cooperative Group for Neuroendocrine Tumors" (KSPNN) has been conducting a nationwide neuroendocrine tumors registry since June 2009. The first data summary after three years is aimed at evaluation of feasibility and data utility.
The anonymous data on diagnostics, therapy and follow up of patients with neuroendocrine tumors of any primary site are collected in the registry. The contribution is conditioned by morphologically proven diagnosis according to the current WHO 2010 classification, in earlier cases WHO 2000 classification. The registry is operated by the Institute of Biostatistics and Analyses, Masaryk University (Brno). The initial analysis includes data from June 2009 to October 2012.
Data of a substantial share of neuroendocrine tumor carriers have been collected - 742 subjects with a valid record, i.e. about 14% of presumed prevalence. Moreover, the registry covers nearly one fourth of incidence in the period 2009- 2011. The morphological diagnoses with the sign of nonspecific "neuroendocrine tumors" comprise the majority of records (75%); the most frequent is "carcinoid tumor neuroendocrine tumors". This results in a clear requirement for more detailed specifications of morphology as well as separation of small cell (neuroendocrine) carcinoma possessing principal bio-logic differences to neuroendocrine tumors itself. There is an apparent polarity of recorded clinical stages. Both stage I and stage IV comprise 30% of the records. This result is presumably related to how the diagnosis is established, either early and incidentally in initial stage or late with a developed endocrine symptomatology, in advanced stage. There is an evident selection bias. The treatment data reflect current trends, dominance of surgical therapy including reasonable cytoreductive surgery, vast use of somatostatine analogues in advanced disease and persistent position of chemotherapy for high grade tumors. The distribution of treatment modalities in the records documents a certain adherence to international treatment standards (ENETS, ESMO, NCCN).
The dynamics of data contributions confirm feasibility of data collection in the registry. The registry reveals a clear requirement for more detailed analyses of biopsies and more detailed disease morphology classification. In the near future, the registry is aimed to maintain the increasing volume of collected data and to cover the majority of neuroendocrine tumors incidence.
神经内分泌肿瘤传统上被认为是“罕见”疾病。相反,神经内分泌肿瘤的患病率很高。因此,神经内分泌肿瘤的诊断、治疗及随访受到越来越多的关注。神经内分泌肿瘤有多种特性,需要对每项干预措施进行适当反馈,即数据收集和集中数据评估。“神经内分泌肿瘤协作组”(KSPNN)自2009年6月起在全国范围内开展神经内分泌肿瘤登记工作。三年后的首次数据总结旨在评估其可行性和数据实用性。
该登记处收集了任何原发部位神经内分泌肿瘤患者的诊断、治疗及随访的匿名数据。数据录入要求根据当前(2010年)世界卫生组织分类经形态学证实的诊断,早期病例则依据2000年世界卫生组织分类。该登记处由马萨里克大学(布尔诺)生物统计学与分析研究所运营。初始分析涵盖2009年6月至2012年10月的数据。
已收集到相当一部分神经内分泌肿瘤患者的数据——742名受试者有有效记录,即约占推测患病率的14%。此外,该登记处涵盖了2009 - 2011年近四分之一的发病率。形态学诊断为非特异性“神经内分泌肿瘤”的记录占大多数(75%);最常见的是“类癌肿瘤神经内分泌肿瘤”。这明确表明需要更详细的形态学分类,以及区分与神经内分泌肿瘤本身具有主要生物学差异的小细胞(神经内分泌)癌。记录的临床分期存在明显的两极分化。I期和IV期均占记录的30%。这一结果可能与诊断确立的方式有关,要么在疾病早期偶然发现,要么在晚期出现明显内分泌症状时确诊。存在明显的选择偏倚。治疗数据反映了当前的趋势,手术治疗占主导地位,包括合理的减瘤手术,晚期疾病中广泛使用生长抑素类似物,以及高级别肿瘤化疗的持续应用。记录中治疗方式的分布表明在一定程度上遵循了国际治疗标准(ENETS、ESMO、NCCN)。
数据贡献的动态变化证实了登记处数据收集的可行性。该登记处表明,显然需要对活检进行更详细的分析,并对疾病形态进行更细致的分类。在不久的将来,该登记处旨在维持不断增加的收集数据量,并涵盖大多数神经内分泌肿瘤的发病率。