SFEBES2019 FEATURED CLINICAL CASE POSTERS (10 abstracts)
Well-differentiated grade 3 neuroendocrine tumors (G3NET) – single centre experience from the UK
Hema Venkataraman 1 , Kirstie Lithgow 1, , Stacey Smith 1 , Joanne Kemp-Blake 1 , Suzanne Vickrage 1 , Simon Hughes 1 , Shishir Shetty 1 , Mona Elshafie 1 , Rakesh Gadvi 1 , Salil Kharkhanis 1 , John Ayuk 1 , Ian Geh 1 & Tahir Shah 1
1University Hospitals Birmingham, Birmingham, UK; 2University of Calgary, Calgary, Canada
Introduction: The WHO classification distinguishes G3NET as a separate entity. Literature on G3NETs is limited to case-reports and small case-series. We aimed to characterise G3NETs from a large tertiary centre.
Methods: Retrospective analysis from NET database: 2012–2019. All referrals are discussed at a specialist NET-MDT before entry into clinical pathway. Core NET-MDT consists of a radiologist, nuclear-medicine radiologist, histopathologist, specialist-nurses, gastroenterologist, oncologist, endocrinologist, and liver surgeons. Imaging and biochemistry is performed every 6 months or as clinically indicated.
Results: 40 G3NETs were identified, with complete data available for 22 at the time of this abstract. Mean(S.D.) age was 69.18(11.1) years (6 females, 16 males). 36.3%(8/22) had undetectable primary, 13.6%(3/22) pancreatic, 13.6%(3/22) small bowel, remaining were colonic, gastric, lung and rectal primary tumours. Median: Ki67 – 30%, range: 25–60% 12/16 had positive or equivocal somatostatin-receptor(SSR) status on imaging. 1 Rectal NET and 3 with undetectable primary had negative SSR imaging. Chromogrannin-A(CGA) and CGB were elevated in 18/22 different patients with mean(S.D.) of 644.592(592.80) pmol/l and 722.45(735.61) pmol/l respectively. Urine HIAA was elevated in 17/22 with mean(S.D.) of 819(813.23). 5/22 had normal levels of all tumor-markers (2 colonic, 1 rectal, 1 unknown and 1 pancreatic). 10/22 received Somatostatin-analogues(SSA): all SSR positive with at-least one elevated tumor-marker. There was no significant change in tumor-marker after SSA. 9/22 received chemotherapy (5/22 capecitabine+temazolamide, 3/22 carboplatin+etopiside, 1 everolimus, 1 FOLFIRI). 5/22 had both SSA & chemotherapy. 0 received PRRT. Of 16 deaths (69.5%), mean length of survival after referral was 15.6 months. Survival >6 months was associated with chemotherapy +/− SSA treatment.
Conclusion: Data from one of UK’s largest specialist NET centres, show G3NETs have high mortality with variable tumor behaviour. G3NETs should be managed in specialist centres with NET-MDT expertise.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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