Departments of Medicine I, Division of Oncology.
Departments of Pathology.
ESMO Open. 2022 Jun;7(3):100478. doi: 10.1016/j.esmoop.2022.100478. Epub 2022 May 4.
The use of somatostatin analogues (SSAs) has not been formally approved in pulmonary neuroendocrine tumours (NETs) in the absence of positive controlled trials, even though it is recommended as a potential therapeutic option in recent guidelines.
We have assessed the use of SSA in the general practice in Austria by retrospectively analysing patients with pulmonary NETs referred to our European Neuroendocrine Tumor Society centre in Vienna for second opinion or further therapy. In addition, we have analysed the somatostatin receptor (SSTR) expression of those patients by immunohistochemistry (IHC) and SSTR imaging, e.g. Ga-DOTANOC-positron emission tomography/computed tomography, and whether such analyses had been carried out before referral at our centre.
Out of 34 patients (19 atypical and 15 typical carcinoids) with metastatic or advanced disease, 10/34 (29%) had been prescribed SSA before referral. No IHC for SSTR had been carried out, and only 9/34 (27%) had undergone SSTR imaging by nuclear medicine. Sufficient material for IHC was available in 29/34 (85%) patients and SSTR-IHC was rated negative in 13/29 (45%), weakly positive in 4/29 (14%), moderately positive in 5/29 (17%) and strongly positive in 7/29 (24%) patients. On SSTR imaging, 8/34 patients (24%) were positive, 13/34 (38%) negative and 13/34 patients (38%) showed a mix of positive and negative NET lesions. In 11/29 (38%) patients with both IHC and imaging available, discordance of SSTR expression on imaging and histological assessment was detected.
These data show that uncritical use of SSA should be discouraged, and assessment of SSTR, preferably by imaging, is mandatory before prescription of SSA in pulmonary NETs.
尽管最近的指南推荐将生长抑素类似物（SSA）作为一种潜在的治疗选择，但由于缺乏阳性对照试验，SSA 在肺神经内分泌肿瘤（NET）中的使用尚未得到正式批准。
我们通过回顾性分析转诊至维也纳欧洲神经内分泌肿瘤学会中心的肺 NET 患者，评估了奥地利普通实践中 SSA 的使用情况。此外，我们还通过免疫组织化学（IHC）和生长抑素受体（SSTR）成像（例如 Ga-DOTANOC 正电子发射断层扫描/计算机断层扫描）分析了这些患者的 SSTR 表达情况，并分析了这些分析是否在转诊至我们中心之前进行。
在 34 例（19 例不典型类癌和 15 例典型类癌）转移性或晚期疾病患者中，有 10/34（29%）在转诊前已被开具 SSA。未进行 SSTR 的 IHC 检测，仅有 9/34（27%）接受了核医学 SSTR 成像。29/34（85%）例患者有足够的 IHC 材料，29/34 例患者的 SSTR-IHC 评分为阴性 13/29（45%），弱阳性 4/29（14%），中度阳性 5/29（17%），强阳性 7/29（24%）。在 SSTR 成像中，8/34 例患者（24%）为阳性，13/34 例（38%）为阴性，13/34 例患者（38%）NET 病变呈阳性和阴性混合。在有 IHC 和成像的 11/29 例（38%）患者中，发现成像和组织学评估的 SSTR 表达存在差异。
这些数据表明，不应不恰当地使用 SSA，并且在肺 NET 中开具 SSA 之前，必须对 SSTR 进行评估，最好通过成像进行。
