METHODS: Clinical records of patients from four Italian referral Centers were retrospectively analyzed to correlate clinical/biological data with clinical outcomes. All the surgical specimens were centrally reviewed.
RESULTS: Clinical data and surgical samples of 51 patients during 1995-2015 were analyzed. Sites of origin were: 32 colorectal, 14 gastro-esophageal, and 5 pancreatobiliary. Twenty-one out of fifty-one (42.2%) developed metachronous distant metastases. Only 5/51 (9.8%) patients received peri-operative therapy, and 23/51 (45.1%) first-line chemotherapy, mostly fluoropyrimidines/oxaliplatin. The NEN component was poorly differentiated in the whole population. Patients with Ki67 index < 55% in the NEC component had a significantly longer median overall survival (OS) (35.3 months; 95% CI 27.1-41.0) than those with Ki67 ≥ 55% (11.9 months; 95% CI 9.1-14.0) P = 0.0005. The median OS was 14 months (95% CI 10.1-19.1) in the whole cohort, with 11.4 months (95% CI 6.2-20.2) in patients who received a first-line therapy.
CONCLUSIONS: This study confirms that GEP-MiNENs represent a complex disease and that over the past years the clinical management has been predominantly guided by the subjective judgment of the clinicians. Although, in this series, the NEC component appeared mostly responsible for the systemic spread and prognosis on the whole neoplasm, the lack of strong prognostic and predictive factors universally recognized seems to condition their management so far. Future prospective clinical and biomolecular studies could help clinicians to improve clinical management of GEP-MiNENs.
方法:回顾性分析四个意大利转诊中心患者的临床记录,以将临床/生物学数据与临床结果相关联。对所有手术标本进行集中检查。
结果:分析了1995-2015年期间51例患者的临床数据和手术样本。起源地点是:32结直肠,14胃食管,和5个胰胆管。51人中有21人(42.2%)发生了异时远处转移。只有5/51(9.8%)的患者接受了围手术期治疗,和23/51(45.1%)一线化疗,主要是氟嘧啶/奥沙利铂。NEN成分在整个人群中的分化程度很低。NEC中Ki67指数<55%的患者的中位总生存期(OS)(35.3个月;95%CI27.1-41.0)明显长于Ki67≥55%(11.9个月;95%CI9.1-14.0)的患者,P=0.0005。在整个队列中,中位OS为14个月(95%CI10.1-19.1),接受一线治疗的患者为11.4个月(95%CI6.2-20.2)。
结论:本研究证实GEP-MINENs是一种复杂的疾病,在过去几年中,临床管理主要由临床医生的主观判断指导。虽然,在这个系列中,NEC成分似乎主要负责整个肿瘤的全身扩散和预后,到目前为止,缺乏公认的强有力的预后和预测因素似乎是他们管理的条件。未来的前瞻性临床和生物分子研究可以帮助临床医生改善GEP-MINENs的临床管理。