Özaslan Ersin, Karaca Halit, Koca Sinan, Sevinç Alper, Hacioğlu Bekir, Özkan Metin, Özçelik Melike, Duran Ayşe O, Hacibekiroğlu İlhan, Yildiz Yaşar, Tanriverdi Özgür, Menekşe Serkan, Aksoy Asude, Bozkurt Oktay, Urvay Semiha, Uysal Mükremin, Demir Hacer, Çiltaş Aydin, Dane Faysal
aDivision of Medical Oncology, Erciyes University School of Medicine, Kayseri bDivision of Medical Oncology, Marmara University School of Medicine cDivision of Medical Oncology, Kartal Training and Research Hospital, İstanbul dDivision of Medical Oncology, Gaziantep University School of Medicine, Gaziantep eDivision of Medical Oncology, Trakya University School of Medicine, Edirne fDivision of Medical Oncology, Abdurrahman Yurtaslan Training and Research Hospital gDivision of Medical Oncology, Gazi University School of Medicine, Ankara hDivision of Medical Oncology, İzmir Katip Çelebi University School of Medicine, İzmir iDivision of Medical Oncology, Muğla Sitki Koçman University School of Medicine, Muğla jDivision of Medical Oncology, Celal Bayar University School of Medicine, Manisa kDivision of Medical Oncology, Firat University School of Medicine, Elaziğ lDivision of Medical Oncology, Cumhuriyet University School of Medicine, Sivas mDivision of Medical Oncology, Afyon Kocatepe University School of Medicine, Afyon, Turkey.
Anticancer Drugs. 2017 Feb;28(2):222-229. doi: 10.1097/CAD.0000000000000445.
The objectives of this study were to compare progression-free survival (PFS) with somatostatin analog (SSA) versus chemotherapy (CTx) in first-line therapy and to determine the patient group in which these treatments were more effective in neuroendocrine tumors (NETs) with a Ki-67 index of 20% or less. Patients who received SSA or CTx and had unresectable locally advanced and metastatic NETs with a Ki-67 index of 20% or less were retrospectively selected from 13 centers in the Turkish database between 2000 and 2015. One hundred and sixty-five patients were enrolled. The median age was 56 years and the male-to-female ratio was 1.09. Seventy-four (45%) patients were of grade 1 NET and 91 (55%) were of grade 2. SSA was given to 104 patients, whereas 61 were treated with CTx. The objective response rate after SSA was 15.4%; another 73.1% had stable disease. The objective response rate after CTx was 36.1%, and 40.9% had stable disease (P=0.008). The median PFS in SSA patients was 21 months (95% confidence interval: 12.4-29.6), and 8 months for CTx (95% confidence interval: 5.5-10.6) (P<0.001). There was no significant difference between PFS of receiving SSA and CTx in pancreatic neuroendocrine tumor (PNET) patients; however, the PFS of receiving SSA was longer in non-PNET patients (P<0.001). SSA was better treatment in advanced NET patients with a Ki-67 index of less than 5%, having a primary resected and a performance status of 0 (P<0.05). SSA may be preferred over CTx in advanced NET patients with low-to-intermediate grade.
本研究的目的是比较一线治疗中生长抑素类似物（SSA）与化疗（CTx）的无进展生存期（PFS），并确定在Ki-67指数为20%或更低的神经内分泌肿瘤（NETs）中，这些治疗对哪些患者群体更有效。2000年至2015年间，从土耳其数据库的13个中心回顾性选取接受SSA或CTx治疗、患有不可切除的局部晚期和转移性NETs且Ki-67指数为20%或更低的患者。共纳入165例患者。中位年龄为56岁，男女比例为1.09。74例（45%）患者为1级NET，91例（55%）为2级。104例患者接受SSA治疗，61例接受CTx治疗。SSA治疗后的客观缓解率为15.4%；另有73.1%疾病稳定。CTx治疗后的客观缓解率为36.1%，40.9%疾病稳定（P=0.008）。接受SSA治疗患者的中位PFS为21个月（95%置信区间：12.4 - 29.6），接受CTx治疗患者的中位PFS为8个月（95%置信区间：5.5 - 10.6）（P<0.001）。胰腺神经内分泌肿瘤（PNET）患者接受SSA和CTx治疗的PFS无显著差异；然而，非PNET患者接受SSA治疗的PFS更长（P<0.001）。对于Ki-67指数小于5%、已进行原发灶切除且体能状态为0的晚期NET患者，SSA是更好的治疗方法（P<0.05）。对于低至中级别的晚期NET患者，SSA可能比CTx更受青睐。
