Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
Neuroendocrinology. 2018;107(1):32-41. doi: 10.1159/000488394. Epub 2018 Mar 14.
There is no consensus regarding optimal follow-up in resected gastroenteropancreatic neuroendocrine tumours (NETs). We aimed to perform a practice survey to ascertain follow-up patterns by health care practitioners and highlight areas of variation that may benefit from further quantitative research.
A Web-based survey targeted at NET health care providers in Australia, New Zealand, Canada, and the USA was developed by a steering committee of medical oncologists and a research methodologist. Thirty-seven questions elicited information regarding adherence to guidelines, the influence of risk factors on follow-up, and the frequency and choice of modality in follow-up.
There were 163 respondents: 59 from Australia, 25 from New Zealand, 46 from Canada, and 33 from the USA (50% medical oncology, 23% surgery, 13% nuclear medicine, and 15% other). Thirty-eight percent of the respondents were "very familiar" with the NCCN NET guidelines, 33% with the ENETS guidelines, and 17% with the ESMO guidelines; however, only 15, 27, and 10%, respectively, found them "very useful"; 63% reported not using guidelines at their institution. The commonest investigations used were CT scans (66%) and chromogranin A (86%). The US respondents were more likely to follow patients up past 5 years, and the Australian respondents utilized more functional and less cross-sectional imaging. When poor prognostic factors were introduced, the respondents recommended more visits and tests.
This large international survey highlights variation in current follow-up practices not well addressed by the current guidelines. More quantitative research is required to inform the development of evidence-based guidelines tailored to the pattern of recurrence in NETs.
对于胃肠胰神经内分泌肿瘤（NET）切除术后的最佳随访，目前尚无共识。我们旨在进行一项实践调查，以确定医疗保健提供者的随访模式，并强调可能受益于进一步定量研究的差异领域。
由医学肿瘤学家和研究方法学家组成的指导委员会开发了一项针对澳大利亚、新西兰、加拿大和美国的 NET 医疗保健提供者的基于网络的调查。37 个问题旨在了解对指南的遵守情况、危险因素对随访的影响以及随访中的频率和选择模式。
共有 163 名受访者：59 名来自澳大利亚，25 名来自新西兰，46 名来自加拿大，33 名来自美国（50%为医学肿瘤学，23%为外科，13%为核医学，15%为其他）。38%的受访者对 NCCN NET 指南“非常熟悉”，33%对 ENETS 指南“非常熟悉”，17%对 ESMO 指南“非常熟悉”；然而，只有 15%、27%和 10%的人分别认为它们“非常有用”；63%的人报告说他们所在的机构没有使用指南。最常用的检查是 CT 扫描（66%）和嗜铬粒蛋白 A（86%）。美国受访者更有可能在 5 年以上随访患者，而澳大利亚受访者则更多地使用功能性检查而不是横断面成像。当引入不良预后因素时，受访者建议进行更多的就诊和检查。
这项大型国际调查强调了目前指南无法很好解决的当前随访实践中的差异。需要更多的定量研究来为制定基于 NET 复发模式的循证指南提供信息。
