Mansoor Wasat, Ferguson Stuart, Ross Victoria, Talbot Denis
The Christie NHS Foundation Trust, Wilmslow Rd., Manchester M20 4BX, UK.
Novartis Pharmaceuticals UK Limited, 2nd Floor, The WestWorks Building, White City Place, 195 Wood Lane, London W12 7FQ, UK.
Int J Endocrinol. 2020 Feb 28;2020:9287536. doi: 10.1155/2020/9287536. eCollection 2020.
There is inconsistency among published guidelines for the optimal diagnostic and management pathways for patients with typical (TC) or atypical (AC) pulmonary carcinoid tumours. We conducted a UK-wide clinician survey to assess current practice for the diagnosis, management, and follow-up of patients with TC/AC and descriptively compared management between European Neuroendocrine Tumor Society (ENETS) accredited centres of excellence (CoE) and nonaccredited centres (non-CoE). Twenty-seven clinicians (10 CoE; 17 non-CoE) participated. Computed tomography of thorax, abdomen, and pelvis was the most commonly reported diagnostic tool (96% of respondents), and bone scans and gallium somatostatin receptor scintigraphy positron emission tomography (SRS PET) were the least commonly reported (30% and 37% of respondents, respectively). Adjuvant therapy is considered for resected TC/AC by <5% of respondents for patients with stage N0 M0 AC or TC, up to 48% of respondents for patients with AC with R1 disease. Somatostatin analogues were the most commonly reported first-line treatment (63% of respondents), and chemotherapy was the most commonly reported second-line therapy and third-line therapy (33% and 41%, respectively) for unresectable and metastatic disease. Reported frequency of initial follow-up after primary surgery ranged from every 2 months to annual, and total follow-up duration ranged from 2 years to indefinite depending on disease type (TC/AC) and stage. For most diagnostic investigations, the highest reported frequency of use was in CoE, most notably gallium SRS PET (70% CoE vs. 18% non-CoE respondents). 93% of respondents (100% CoE; 88% non-CoE) reported having neuroendocrine tumour- (NET-) specialist multidisciplinary team meetings at their centre; 59% (90% CoE; 41% non-CoE) had a NET Clinical Nurse Specialist (CNS) and 48% (80% CoE; 29% non-CoE) had a lung NET patient database. The survey results suggest variability between UK centres in diagnostic pathways and management of patients with TC/AC and suggest that CoE may be able to offer an improved service to patients.
对于典型（TC）或非典型（AC）肺类癌肿瘤患者的最佳诊断和管理路径，已发表的指南之间存在不一致性。我们在英国范围内开展了一项临床医生调查，以评估TC/AC患者诊断、管理及随访的当前实践情况，并对欧洲神经内分泌肿瘤学会（ENETS）认可的卓越中心（CoE）和非认可中心（非CoE）之间的管理情况进行描述性比较。27名临床医生（10名CoE；17名非CoE）参与了调查。胸部、腹部和骨盆的计算机断层扫描是最常报告的诊断工具（96%的受访者），而骨扫描和镓生长抑素受体闪烁显像正电子发射断层扫描（SRS PET）报告最少（分别为30%和37%的受访者）。对于N0 M0期AC或TC患者，<5%的受访者考虑对切除的TC/AC进行辅助治疗；对于R1期疾病的AC患者，高达48%的受访者考虑进行辅助治疗。生长抑素类似物是最常报告的一线治疗方法（63%的受访者），化疗是不可切除和转移性疾病最常报告的二线和三线治疗方法（分别为33%和41%）。初次手术后报告的初始随访频率从每2个月到每年不等，总随访时间从2年到不确定，具体取决于疾病类型（TC/AC）和分期。对于大多数诊断检查，报告使用频率最高的是在CoE，最显著的是镓SRS PET（70%的CoE受访者 vs. 18%的非CoE受访者）。93%的受访者（100%的CoE；88%的非CoE）报告其中心有神经内分泌肿瘤（NET）专家多学科团队会议；59%（90%的CoE；41%的非CoE）有NET临床护士专家（CNS），48%（80%的CoE；29%的非CoE）有肺NET患者数据库。调查结果表明，英国各中心在TC/AC患者的诊断路径和管理方面存在差异，并且表明CoE可能能够为患者提供更好的服务。
