背景:最近的指南已由国际专家达成共识(2016ENETS(欧洲神经内分泌肿瘤学会)指南)发表。然而,在胰腺神经内分泌肿瘤(panNEN)的情况下,ENETS指南在某些情况下未能提出独特的策略,由于缺乏高水平的证据以及起草指南的专家之间缺乏正式协议。
方法:一项关于panNEN的25个问题的调查被发送给104名法国专家,对指南提出质疑。问题集中在局部G-1/2panNEN的临床情况,局域化的G-3PanNEN,转移性G-1/2panNEN,和转移性G-3panNEN,ENETS指南提出了多种选择。
结果:57位专家(55%)回答了调查。18/25个问题获得了至少50%的相似回答,允许“共识”或“立场声明”。在结果中,对于年轻患者,小panNEN的手术优于监测;对于G-1/2转移性panNEN,替莫唑胺-卡培他滨联合用药较以链脲佐菌素为基础的化疗更受青睐.
结论:法国专家大多符合欧洲指南,但是确实存在一些差异。在等待前瞻性研究的同时,这项调查有助于医生提出标准化程序,并确定法国专家向前迈出一步的情况。该问卷为panNEN的简化治疗算法铺平了道路。
BACKGROUND: Recent
guidelines have been published by a
consensus of international experts (2016 ENETS (European NeuroEndocrine Tumor Society)
guidelines). Nevertheless, in case of pancreatic neuroendocrine neoplasms (panNEN) the ENETS
guidelines fail to propose a unique strategy in some situations, due to the lack of high-level of evidence and the absence of formal agreement between the experts drawing up the
guidelines.
METHODS: A survey of 25 questions on panNEN was sent to 104 French experts challenging the guidelines. Questions focused on clinical situations in localized G-1/2 panNEN, localized G-3 panNEN, metastatic G-1/2 panNEN, and metastatic G-3 panNEN for which multiple options were proposed by the ENETS guidelines.
RESULTS: Fifty-seven experts (55%) have answered the survey. 18/25 questions obtained at least 50% similar responses, allowing a \"
consensus\" or a \"position statement\". Among the results, surgery of small panNEN is preferred to surveillance in young patients; the temozolomide-capecitabine combination is favored instead of streptozotocin-based chemotherapy for G-1/2 metastatic panNEN.
CONCLUSIONS: French experts are mostly in line with the European guidelines, but some differences do exist. Whilst waiting for prospective studies, this survey helps physicians to propose standardized procedures and identifies situations where a step forward has been enabled by French experts. This questionnaire paves the way for a simplified therapeutic algorithm of panNEN.