Abstract
Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are a very aggressive type of cancer, for which prognostic factors are lacking. We analysed clinical and histomorphological prognostic markers of overall survival (OS), completed with a record of biological and haematological data of patients diagnosed between December 2002 and December 2015. The median OS was 16 months (95% CI 13.9–18.1). After univariate analysis, performance status (PS) ≥ 2 and stage IV were associated with a worse outcome (9 months and 14 months, respectively), as well as patients with lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels ≥ 2 ULN (9 months and 8 months, respectively). After multivariate analysis, LDH and AST levels were the only factors that remained significantly associated with better survival: HR 0.36 (p = 0.04) and 0.31 (p = 0.03), respectively. When patients had elevated LDH and AST levels, OS was 20 months, when they had high LDH or AST levels, 13 months and 8 months in the group with low LDH and AST levels (p < 0.001). Therefore, biological data appeared to be more relevant prognostic factors than usual factors described in other studies (PS, stage, and Ki-67). Considering LDH and AST levels at diagnosis could help physicians to predict survival and to stratify patients for clinical trials.
Highlights
Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) represent less than 1% of digestive cancers and 7 to 21% of neuroendocrine neoplasms[1]
A total of 109 patients referred to the Edouard Herriot hospital (Lyon, France) between 2002 and 2015 for GEP-NEC were identified
The aim of this study was to analyse several prognostic factors in a GEP-NEC cohort, including a review of biological factors in addition to other characteristics already identified at baseline in this tumour type, namely clinical, morphological, and histological factors
Summary
Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) represent less than 1% of digestive cancers and 7 to 21% of neuroendocrine neoplasms[1]. Recent studies have reported the potential of blood transcript analysis as a predictive and prognostic marker of progression in well-differentiated NET9,10, but this was not studied in NEC patients. Molecular analysis, such as p53 and retinoblastoma (RB) protein staining, are Oncogénèse, Centre de Recherche en Cancérologie de Lyon, UMR Inserm 1052 CNRS 5286, 69373 Lyon cedex 08, France. Probably promising in NEC11, but these analyses are not validated for survival prognosis in NEC In this context, we conducted a retrospective study to evaluate usual relevant clinical and histomorphological prognostic markers of overall survival in patients with NEC, completed with biological and haematological data, which are convenient and directly available to physicians
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