Grimaldi Franco, Fazio Nicola, Attanasio Roberto, Frasoldati Andrea, Papini Enrico, Cremonini Nadia, Davi Maria V, Funicelli Luigi, Massironi Sara, Spada Francesca, Toscano Vincenzo, Versari Annibale, Zini Michele, Falconi Massimo, Oberg Kjell
Endocrinology and Metabolic Disease Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumor, European Institute of Oncology, Milan, Italy.
Endocr Metab Immune Disord Drug Targets. 2018;18(5):419-449. doi: 10.2174/1871530318666171213145803.
Well-established criteria for evaluating the response to treatment and the appropriate followup of individual patients are critical in clinical oncology. The current evidence-based data on these issues in terms of the management of gastroenteropancreatic (GEP) neuroendocrine neoplasms (NEN) are unfortunately limited. This document by the Italian Association of Clinical Endocrinologists (AME) on the criteria for the follow-up of GEP-NEN patients is aimed at providing comprehensive recommendations for everyday clinical practice based on both the best available evidence and the combined opinion of an interdisciplinary panel of experts. The initial risk stratification of patients with NENs should be performed according to the grading, staging and functional status of the neoplasm and the presence of an inherited syndrome. The evaluation of response to the initial treatment, and to the subsequent therapies for disease progression or recurrence, should be based on a cost-effective, risk-effective and timely use of the appropriate diagnostic resources. A multidisciplinary evaluation of the response to the treatment is strongly recommended and, at every step in the follow-up, it is mandatory to assess the disease state and the patient performance status, comorbidities, and recent clinical evolution. Local expertise, available technical resources and the patient preferences should always be evaluated while planning the individual clinical management of GEP-NENs.
在临床肿瘤学中，确立完善的治疗反应评估标准以及对个体患者进行适当的随访至关重要。遗憾的是，目前关于胃肠胰（GEP）神经内分泌肿瘤（NEN）管理方面这些问题的循证数据有限。意大利临床内分泌学家协会（AME）的这份关于GEP-NEN患者随访标准的文件旨在基于现有最佳证据以及跨学科专家小组的综合意见，为日常临床实践提供全面建议。NEN患者的初始风险分层应根据肿瘤的分级、分期、功能状态以及是否存在遗传综合征来进行。对初始治疗以及疾病进展或复发的后续治疗反应的评估，应基于对适当诊断资源的经济有效、风险有效且及时的利用。强烈建议对治疗反应进行多学科评估，并且在随访的每一步，都必须评估疾病状态、患者的体能状态、合并症以及近期临床进展。在规划GEP-NEN的个体临床管理时，应始终评估当地的专业知识、可用的技术资源以及患者的偏好。
