Hall Lewis A, Powell-Brett Sarah, Thompson Oscar, Smith Daniel, Bradley Elizabeth, Smith Stacey, Vickrage Suzanne, Kemp-Blake Joanne, Roberts Keith J, Shah Tahir
College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
The Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK.
Cancers (Basel). 2023 Mar 23;15(7):1933. doi: 10.3390/cancers15071933.
Somatostatin-analogues (SSAs) are a first-line treatment of unresectable neuroendocrine tumours (NETs). However, SSAs inhibit pancreatic secretions, which could lead to pancreatic exocrine insufficiency (PEI). PEI is known to be detrimental to patient quality of life and nutritional status. This study aimed to evaluate the effect of SSAs on pancreatic exocrine function in patients with NETs, using the C-mixed triglyceride breath test (C-MTGT). Exocrine function was assessed using the C-MTGT at baseline and after a third SSA injection (two months). A quotient of CO/CO was measured by mass spectrometry, and the cumulative percent dose recovered at 6 h (cPDR) is reported. The secondary endpoints investigated were change in weight, HbA1C, and vitamin D levels. Ten patients completed the study. Exocrine function reduced in all patients (n = 10) following SSA therapy (median reduction from baseline: -23.4% (range: -42.1-0.5%, = 0.005)). vitamin D levels decreased in all but one patient (median decrease from baseline: -26.5%, (-44.7-10%; = 0.038)), and median HbA1C levels increased by 8.0% (0-59.3%; = 0.008). Change in weight was not significant (median decrease from baseline: -0.21% (-4.5-3.5%, = 1.000)). SSA therapy has a consistent impact on exocrine function from early in the treatment course, but the long-term clinical effects of this remain to be defined. Further studies are required to determine the clinical relevance of this observation and optimise the management of PEI in this cohort.
生长抑素类似物（SSAs）是不可切除神经内分泌肿瘤（NETs）的一线治疗药物。然而，SSAs会抑制胰腺分泌，这可能导致胰腺外分泌功能不全（PEI）。已知PEI对患者的生活质量和营养状况有害。本研究旨在使用C-混合甘油三酯呼气试验（C-MTGT）评估SSAs对NETs患者胰腺外分泌功能的影响。在基线时以及第三次注射SSA后（两个月），使用C-MTGT评估外分泌功能。通过质谱法测量CO/CO的商，并报告6小时时累积回收剂量百分比（cPDR）。研究的次要终点包括体重、糖化血红蛋白（HbA1C）和维生素D水平的变化。10名患者完成了研究。SSA治疗后所有患者（n = 10）的外分泌功能均降低（与基线相比中位数降低：-23.4%（范围：-42.1 - 0.5%，P = 0.005））。除一名患者外，所有患者的维生素D水平均下降（与基线相比中位数下降：-26.5%，（-44.7 - 10%；P = 0.038）），HbA1C水平中位数升高8.0%（0 - 59.3%；P = 0.008）。体重变化不显著（与基线相比中位数下降：-0.21%（-4.5 - 3.5%，P = 1.000））。SSA治疗在治疗过程早期对外分泌功能有持续影响，但其长期临床效果仍有待确定。需要进一步研究以确定这一观察结果的临床相关性，并优化该队列中PEI的管理。
