Heterogeneity of Duodenal Neuroendocrine Tumors: An Italian Multi-center Experience

Sara Massironi, Davide Campana, Stefano Partelli, Francesco Panzuto, Roberta Elisa Rossi, Antongiulio Faggiano, Nicole Brighi, Massimo Falconi, Maria Rinzivillo, Gianfranco Delle Fave, Anna Maria Colao, Dario Conte

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The optimal management of duodenal neuroendocrine neoplasms (dNENs) is unclear, and endoscopic resection is increasingly performed instead of surgery. Methods: This is a retrospective analysis of patients with histologically confirmed diagnosis of dNENs, managed at five Italian tertiary referral Centers in Italy. Results: From 2000 to 2017, 108 patients (69 males, 39 females, median age 59.5 years) were included in this study. Seventy-one patients had G1, 21 G2, 4 G3 dNENs (12 Ki-67 not available). Fifty-four patients showed metastases at diagnosis, and 20 patients developed metachronous metastases. Thirty patients had a functioning dNEN (14 metastatic). Fifty-seven patients had the dNEN surgically resected, 16 endoscopically, 23 metastatic, received medical therapy + surgery or endoscopy. Seven patients underwent liver-directed therapies, and one patient had PRRT. Median OS was 187 months. During a median follow-up of 76 months, 20 patients died (19 of disease-related causes). At Cox’s multivariate proportional hazard regression, grading and age were the only variables independently related to OS. Median PFS was 170 months. Grading and staging at the initial diagnosis were independently related to PFS. No differences in terms of OS and PFS were observed between patients treated surgically or endoscopically. Conclusions: dNENs prognosis may be highly variable. These tumors can be metastatic in up to 50% of cases at the time of first diagnosis and can develop metastases thereafter. Functioning neoplasms express high metastatic potential. Nuclear imaging should be performed to exclude distant metastases in all dNENs. Endoscopy and surgery play a primary role in the management of the disease. Further prospective studies are needed.

Original languageEnglish
JournalAnnals of Surgical Oncology
DOIs
Publication statusPublished - 2018

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Neuroendocrine Tumors
Duodenal Neoplasms
Neoplasm Metastasis
Endoscopy
Disease Management
Tertiary Care Centers
Italy
Neoplasms
Prospective Studies

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Heterogeneity of Duodenal Neuroendocrine Tumors : An Italian Multi-center Experience. / Massironi, Sara; Campana, Davide; Partelli, Stefano; Panzuto, Francesco; Rossi, Roberta Elisa; Faggiano, Antongiulio; Brighi, Nicole; Falconi, Massimo; Rinzivillo, Maria; Delle Fave, Gianfranco; Colao, Anna Maria; Conte, Dario.

In: Annals of Surgical Oncology, 2018.

Research output: Contribution to journalArticle

Massironi, S, Campana, D, Partelli, S, Panzuto, F, Rossi, RE, Faggiano, A, Brighi, N, Falconi, M, Rinzivillo, M, Delle Fave, G, Colao, AM & Conte, D 2018, 'Heterogeneity of Duodenal Neuroendocrine Tumors: An Italian Multi-center Experience', Annals of Surgical Oncology. https://doi.org/10.1245/s10434-018-6673-5
Massironi, Sara ; Campana, Davide ; Partelli, Stefano ; Panzuto, Francesco ; Rossi, Roberta Elisa ; Faggiano, Antongiulio ; Brighi, Nicole ; Falconi, Massimo ; Rinzivillo, Maria ; Delle Fave, Gianfranco ; Colao, Anna Maria ; Conte, Dario. / Heterogeneity of Duodenal Neuroendocrine Tumors : An Italian Multi-center Experience. In: Annals of Surgical Oncology. 2018.
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abstract = "Background: The optimal management of duodenal neuroendocrine neoplasms (dNENs) is unclear, and endoscopic resection is increasingly performed instead of surgery. Methods: This is a retrospective analysis of patients with histologically confirmed diagnosis of dNENs, managed at five Italian tertiary referral Centers in Italy. Results: From 2000 to 2017, 108 patients (69 males, 39 females, median age 59.5 years) were included in this study. Seventy-one patients had G1, 21 G2, 4 G3 dNENs (12 Ki-67 not available). Fifty-four patients showed metastases at diagnosis, and 20 patients developed metachronous metastases. Thirty patients had a functioning dNEN (14 metastatic). Fifty-seven patients had the dNEN surgically resected, 16 endoscopically, 23 metastatic, received medical therapy + surgery or endoscopy. Seven patients underwent liver-directed therapies, and one patient had PRRT. Median OS was 187 months. During a median follow-up of 76 months, 20 patients died (19 of disease-related causes). At Cox’s multivariate proportional hazard regression, grading and age were the only variables independently related to OS. Median PFS was 170 months. Grading and staging at the initial diagnosis were independently related to PFS. No differences in terms of OS and PFS were observed between patients treated surgically or endoscopically. Conclusions: dNENs prognosis may be highly variable. These tumors can be metastatic in up to 50{\%} of cases at the time of first diagnosis and can develop metastases thereafter. Functioning neoplasms express high metastatic potential. Nuclear imaging should be performed to exclude distant metastases in all dNENs. Endoscopy and surgery play a primary role in the management of the disease. Further prospective studies are needed.",
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T1 - Heterogeneity of Duodenal Neuroendocrine Tumors

T2 - An Italian Multi-center Experience

AU - Massironi, Sara

AU - Campana, Davide

AU - Partelli, Stefano

AU - Panzuto, Francesco

AU - Rossi, Roberta Elisa

AU - Faggiano, Antongiulio

AU - Brighi, Nicole

AU - Falconi, Massimo

AU - Rinzivillo, Maria

AU - Delle Fave, Gianfranco

AU - Colao, Anna Maria

AU - Conte, Dario

PY - 2018

Y1 - 2018

N2 - Background: The optimal management of duodenal neuroendocrine neoplasms (dNENs) is unclear, and endoscopic resection is increasingly performed instead of surgery. Methods: This is a retrospective analysis of patients with histologically confirmed diagnosis of dNENs, managed at five Italian tertiary referral Centers in Italy. Results: From 2000 to 2017, 108 patients (69 males, 39 females, median age 59.5 years) were included in this study. Seventy-one patients had G1, 21 G2, 4 G3 dNENs (12 Ki-67 not available). Fifty-four patients showed metastases at diagnosis, and 20 patients developed metachronous metastases. Thirty patients had a functioning dNEN (14 metastatic). Fifty-seven patients had the dNEN surgically resected, 16 endoscopically, 23 metastatic, received medical therapy + surgery or endoscopy. Seven patients underwent liver-directed therapies, and one patient had PRRT. Median OS was 187 months. During a median follow-up of 76 months, 20 patients died (19 of disease-related causes). At Cox’s multivariate proportional hazard regression, grading and age were the only variables independently related to OS. Median PFS was 170 months. Grading and staging at the initial diagnosis were independently related to PFS. No differences in terms of OS and PFS were observed between patients treated surgically or endoscopically. Conclusions: dNENs prognosis may be highly variable. These tumors can be metastatic in up to 50% of cases at the time of first diagnosis and can develop metastases thereafter. Functioning neoplasms express high metastatic potential. Nuclear imaging should be performed to exclude distant metastases in all dNENs. Endoscopy and surgery play a primary role in the management of the disease. Further prospective studies are needed.

AB - Background: The optimal management of duodenal neuroendocrine neoplasms (dNENs) is unclear, and endoscopic resection is increasingly performed instead of surgery. Methods: This is a retrospective analysis of patients with histologically confirmed diagnosis of dNENs, managed at five Italian tertiary referral Centers in Italy. Results: From 2000 to 2017, 108 patients (69 males, 39 females, median age 59.5 years) were included in this study. Seventy-one patients had G1, 21 G2, 4 G3 dNENs (12 Ki-67 not available). Fifty-four patients showed metastases at diagnosis, and 20 patients developed metachronous metastases. Thirty patients had a functioning dNEN (14 metastatic). Fifty-seven patients had the dNEN surgically resected, 16 endoscopically, 23 metastatic, received medical therapy + surgery or endoscopy. Seven patients underwent liver-directed therapies, and one patient had PRRT. Median OS was 187 months. During a median follow-up of 76 months, 20 patients died (19 of disease-related causes). At Cox’s multivariate proportional hazard regression, grading and age were the only variables independently related to OS. Median PFS was 170 months. Grading and staging at the initial diagnosis were independently related to PFS. No differences in terms of OS and PFS were observed between patients treated surgically or endoscopically. Conclusions: dNENs prognosis may be highly variable. These tumors can be metastatic in up to 50% of cases at the time of first diagnosis and can develop metastases thereafter. Functioning neoplasms express high metastatic potential. Nuclear imaging should be performed to exclude distant metastases in all dNENs. Endoscopy and surgery play a primary role in the management of the disease. Further prospective studies are needed.

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