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Lung metastases in patients with well-differentiated gastroenteropancreatic neuroendocrine neoplasms : an appraisal of the validity of thoracic imaging surveillance
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Daskalakis, Kosmas, Tsoli, Marina, Srirajaskanthan, Raj, Chatzellis, Eleftherios, Alexandraki, Krystallenia, Angelousi, Anna, Pizanias, Michail, Randeva, Harpal S., Kaltsas, Gregory and Weickert, Martin O. (2019) Lung metastases in patients with well-differentiated gastroenteropancreatic neuroendocrine neoplasms : an appraisal of the validity of thoracic imaging surveillance. Neuroendocrinology, 108 (4). pp. 308-316. doi:10.1159/000497183
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Official URL: http://dx.doi.org/10.1159/000497183
Abstract
Background/Aims: To evaluate the impact of lung metastases (LM) on overall survival (OS) in well-differentiated (WD) stage IV gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) patients along with developing surveillance strategies for thoracic imaging. Methods: Thirty-four patients with LM, from 3 centres, were identified (22 small intestine/12 pancreatic; 17 grade 1/15 grade 2/2 of unknown grade). For comparison, we used 106 stage IV WD, grade 1 and 2 GEP-NEN patients with metastatic disease confined in the abdomen. Results: LM prevalence was 4.9% (34/692). Eleven patients (32%) presented with synchronous LM whereas 23 (68%) developed metachronous LM at a median of 25 months (range 1–150 months). Patients with metachronous LM had already established liver and/or para-aortic lymph node metastases. Eighteen of 23 patients (78%) with metachronous LM exhibited concomitant progression in the abdomen. Median OS of WD GEP-NEN patients with LM was shorter than for those with stage IV disease without extra-abdominal metastases (56 [95% CI 40.6–71.6] vs. 122.7 [95% CI 70.7–174.8] months; log-rank p = 0.001). Among patients with progressive stage IV disease, the subset of patients with LM exhibited shorter OS (log-rank p = 0.005). LM were also confirmed as an independent prognostic factor for survival in multivariable analysis (HR 0.18; 95% CI 0.07–0.45; p < 0.0001). Conclusion: LM, although relatively rare in patients with WD stage IV GEP-NENs, may impact patients’ outcome. The development of metachronous LM is associated with concomitant disease progression in established abdominal metastases in most patients. These patient-related parameters could be utilized for a stratified surveillance approach, mainly reserving thoracic imaging for GEP-NEN patients with progressive disease in the abdomen.
| Item Type: | Journal Article | ||||
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| Divisions: | Faculty of Medicine > Warwick Medical School > Biomedical Sciences Faculty of Medicine > Warwick Medical School |
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| Journal or Publication Title: | Neuroendocrinology | ||||
| Publisher: | Karger | ||||
| ISSN: | 0028-3835 | ||||
| Official Date: | June 2019 | ||||
| Dates: |
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| Volume: | 108 | ||||
| Number: | 4 | ||||
| Page Range: | pp. 308-316 | ||||
| DOI: | 10.1159/000497183 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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