ECE2016 Eposter Presentations Endocrine tumours and neoplasia (68 abstracts)
Proposal of a two-step dynamic prognostic stratification for stage IV sporadic pancreatic neuroendocrine tumors
Vincenzo Marotta 1 , Thomas Walter 2 , Christine Do Cao 3 , Salvatore Tafuto 4 , Vincenzo Montesarchio 5 , Julia Arfi-Rouche 6 , Pierre Jean Valette 2 , Catherine Lombard-Bohas 2 , Emmanuelle Leteurtre 3 , Isabelle Borget 6 , Jean Yves Scoazec 6 , Michel Ducreux 6 , Antongiulio Faggiano 1, , Annamaria Colao 1 & Eric Baudin 6
1Federico II University, Naples, Italy; 2Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France; 3Lille University Hospital, Lille, France; 4INT Pascale, Naples, Italy; 5Azienda dei Colli Hospital, Naples, Italy; 6Gustave Roussy Institute, Villejuif, France.
Purpose: To validate a prognostic stratification system of overall survival (OS) in stage IV pancreatic neuroendocrine tumors (pNETs) naïve of therapy by analyzing 1) prognostic parameters at the time of stage IV diagnosis; 2) the role of spontaneous tumor slope.
Patients and Methods: Multicenter retrospective study including consecutive patients diagnosed with stage IV pNET from January 1997 to March 2014. Inclusion criteria were: 1. pNET with well-differentiated morphology; 2. measurable stage IV disease; 3. diagnosis and follow-up entirely performed at the participating center. Exclusion criteria were: 1. systemic treatment prior work-up; 2. hereditary syndromes. The primary endpoint was OS. Univariate and multivariate analyses were performed: model 1 “at the time of stage IV diagnosis”; model 2 “after the definition of spontaneous tumor slope”.
Results: Two hundred and eight patients with stage IV pNET were included. Median follow-up was 45 months. Parameters independently associated with OS were: model 1. T parameter (T4, P=0.04), metastatic tumor load (2 sites, P=0.004; >2 sites, P=<0.0001), liver involvement (>70%, P=<0.0001), grade (ki67 and/or mitotic index >10, P=0.01); model 2. T parameter (T4, P=0.04), metastatic tumor load (2 sites, P=0.006; >2 sites, P<0.0001), liver involvement (>70%, P=0.0002), grade (ki67 and/or mitotic index >10, P=0.03), and spontaneous tumor slope (progressive disease, P=0.001).
Conclusions: Based on these results a two-step prognostic stratification of stage IV pNET patients is proposed. This includes the number of tumor organs, liver involvement, T4 and the grade at diagnosis, empowered by tumor slope at the time of first imaging monitoring in patients subjected to watchful follow-up.
Volume 41
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