Abstract
Purpose: Multidisciplinary approach is widely advised for an effective care of patients with neuroendocrine neoplasia (NEN). Since data on efficacy of multidisciplinary management of NENs patients in referral centers are scanty, this study aimed at analyzing the modality of presentation and clinical outcome of patients with NENs managed by a dedicated multidisciplinary team. Methods. In this prospective observational study, we included all consecutive new patients visiting the Sant’Andrea Hospital in Rome (ENETS—Center of Excellence) between January 2014 and June 2018. Results. A total of 195 patients were evaluated. The most frequent sites were pancreas (38.5%), small bowel (22%), and lung (9.7%). Median Ki67 was 3%. After the first visit at the center, additional radiological and/or nuclear medicine procedures were requested in 163 patients (83.6%), whereas histological data revision was advised in 84 patients (43.1%) (revision of histological slides: 27.7%, new bioptic sampling: 15.4%). After that, disease imaging staging and grading was modified in 30.7% and 17.9% of patients, respectively. Overall, a change in therapeutic management was proposed in 98 patients (50.3%). Conclusions. Multidisciplinary approach in a dedicated team may lead to change of disease imaging staging and grading in a significant proportion of patients. Enhancing referral routes to dedicated-NEN center should be promoted, since it may improve patients’ clinical outcome.
Highlights
Neuroendocrine neoplasia (NEN) is a group of rare and heterogenous diseases, in terms of both pathological and clinical features
Since data on the efficacy of multidisciplinary management of patients with NENs in specialized centers with dedicated multidisciplinary team (MDT) are scanty, this study aimed at analyzing the modalities of presentation and clinical outcome of patients with NENs managed in a center of excellence with a dedicated MDT
The present study reports the real-world experience of a referral center in which, according with the ENETS standard of procedures, newly patients are routinely discussed in a multidisciplinary setting
Summary
Neuroendocrine neoplasia (NEN) is a group of rare and heterogenous diseases, in terms of both pathological and clinical features. Their prognosis is affected by several factors, including primary tumor site, staging, and grading [1,2,3]. Surgery is widely considered the sole chance to cure patients; it is often not feasible due to advanced metastatic disease at time of diagnosis In these patients, for whom medical treatment is required, several therapeutic options are available, including somatostatin analogs (octreotide and lanreotide), peptide receptor radionuclide therapy (PRRT), targeted therapies (everolimus and sunitinib), and systemic chemotherapy [4]
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