Advanced digestive neuroendocrine tumors: Metastatic pattern is an independent factor affecting clinical outcome

Francesco Panzuto, Elettra Merola, Maria Rinzivillo, Stefano Partelli, Davide Campana, Elsa Iannicelli, Emanuela Pilozzi, Paolo Mercantini, Michele Rossi, Gabriele Capurso, Aldo Scarpa, Stefano Cascinu, Paola Tomassetti, Massimo Falconi, Gianfranco Delle Fave

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: The objective of this study was to determine the impact of different metastatic spread patterns on outcome in advanced digestive neuroendocrine tumors (NETs). METHODS: This was a retrospective analysis of patients with stage IV NETs, classified as group 1 (unilobar liver metastases), group 2 (bilobar liver metastases), group 3 (extra-abdominal metastases). End points were overall survival (OS) and progression-free survival (PFS). Risk factor analysis was performed using Cox proportional hazard model. RESULTS: Of the 229 patients, 135 (58.9%) had pancreatic, and 94 (41.1%) small bowel NETs: 32 (13.9%) were included in group 1, 179 (78.2%) in group 2, and 18 (7.9%) in group 3. Median Ki67 was 4.5%. Overall, 5-year OS was 55%. Different OS was observed among the 3 groups: median survival not reached, 81 and 8 months, respectively (P <0.001). Median PFS was 18 months. Both OS and PFS were significantly affected by Ki67 and metastatic spread pattern. CONCLUSIONS: The stratification of stage IV NET patients based on metastatic patterns, alongside Ki67, predicts the clinical outcome. The extent of metastatic disease is a previously unrecognized variable, which should be considered when evaluating the results of treatments in NET patients with advanced disease.

Original languageEnglish
Pages (from-to)212-218
Number of pages7
Issue number2
Publication statusPublished - Mar 2014


  • carcinoids
  • metastases
  • neuroendocrine tumors
  • pancreatic endocrine tumors
  • staging

ASJC Scopus subject areas

  • Hepatology
  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism


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