Slott Cecilie, Langer Seppo W, Møller Stine, Krogh Jesper, Klose Marianne, Hansen Carsten Palnæs, Kjaer Andreas, Holmager Pernille, Garbyal Rajendra Singh, Knigge Ulrich, Andreassen Mikkel
ENETS Center of Excellence, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.
Department of Endocrinology and Metabolism, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.
Cancers (Basel). 2024 Jan 1;16(1):204. doi: 10.3390/cancers16010204.
Small intestinal neuroendocrine tumors (siNET) are one of the most common neuroendocrine neoplasms. Radical surgery is the only curative treatment.
We utilized a single-center study including consecutive patients diagnosed from 2000 to 2020 and followed them until death or the end of study. Disease-specific survival and recurrence-free survival (RFS) were investigated by Cox regression analyses with the inclusion of prognostic factors. Aims/primary outcomes: We identified three groups: (1) disease specific-survival in the total cohort (group1), (2) RFS and disease-specific survival after intended radical surgery (group2), (3) disease specific-survival in patients with unresectable disease or residual tumor after primary resection (group3).
In total, 615 patients, with a mean age (SD) 65 ± 11 years were included. Median (IQR) Ki-67 index was 4 (2-7)%. Median disease-specific survival in group1 was 130 months. Median RFS in group2 was 138 months with 5- and 10-year RFS rates of 72% and 59% with age, plasma chromogranin A (p-CgA) and Ki-67 index as prognostic factors. The ten year disease-specific survival rate in group2 was 86%. The median disease-specific survival in group3 was 85 months with age, Ki-67 index, p-CgA and primary tumor resection as prognostic factors. When proliferation was expressed by WHO grade, no difference was observed between G1 vs. G2 for any of the primary outcomes.
Recurrence rates remained high 5-10 years after surgery (group2) supporting long-term follow-up. Median disease-specific survival in patient with unresectable disease (group3) was 7 years, with a favorable impact of primary tumor resection. Our data does not support the current grading system since no significant prognostic information was detected in G1 vs. G2 tumors.
小肠神经内分泌肿瘤（siNET）是最常见的神经内分泌肿瘤之一。根治性手术是唯一的治愈性治疗方法。
我们进行了一项单中心研究，纳入了2000年至2020年连续诊断的患者，并对他们进行随访直至死亡或研究结束。通过Cox回归分析并纳入预后因素来研究疾病特异性生存和无复发生存（RFS）情况。目标/主要结局：我们确定了三组：（1）整个队列中的疾病特异性生存（第1组），（2）意向性根治性手术后的RFS和疾病特异性生存（第2组），（3）不可切除疾病或初次切除后残留肿瘤患者的疾病特异性生存（第3组）。
总共纳入了615例患者，平均年龄（标准差）为65±11岁。Ki-67指数的中位数（四分位间距）为4（2-7）%。第1组的疾病特异性生存中位数为130个月。第2组的RFS中位数为138个月，5年和10年RFS率分别为72%和59%，年龄、血浆嗜铬粒蛋白A（p-CgA）和Ki-67指数作为预后因素。第2组的10年疾病特异性生存率为86%。第3组的疾病特异性生存中位数为85个月，年龄、Ki-67指数、p-CgA和原发肿瘤切除作为预后因素。当按照世界卫生组织分级来表示增殖情况时，在任何主要结局方面，G1与G2之间均未观察到差异。
手术后5至10年复发率仍然很高（第2组），这支持了长期随访。不可切除疾病患者（第3组）的疾病特异性生存中位数为7年，原发肿瘤切除有积极影响。我们的数据不支持当前的分级系统，因为在G1与G2肿瘤中未检测到显著的预后信息。
