scholarly journals Mesenteric fibrosis and palliative surgery in small intestinal neuroendocrine tumours

2018 ◽  
Vol 25 (3) ◽  
pp. 245-254 ◽  
Author(s):  
Anela Blažević ◽  
Wouter T Zandee ◽  
Gaston J H Franssen ◽  
Johannes Hofland ◽  
Marie-Louise F van Velthuysen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neuroendocrine Tumours ◽  
Primary Tumour ◽  
Palliative Surgery ◽  
Ct Imaging ◽  
Prophylactic Surgery ◽  
Imaging Data ◽  
Mesenteric Mass ◽  
Small Intestinal ◽  
Hallmark Feature

Mesenteric fibrosis (MF) surrounding a mesenteric mass is a hallmark feature of small intestinal neuroendocrine tumours (SI-NETs). Since this can induce intestinal obstruction, oedema and ischaemia, prophylactic resection of the primary tumour and mesenteric mass is often recommended. This study assessed the predictors for mesenteric metastasis and fibrosis and the effect of MF and palliative surgery on survival. A retrospective analysis of 559 patients with pathologically proven SI-NET and available CT-imaging data was performed. Clinical characteristics, presence of mesenteric mass and fibrosis on CT imaging and the effect of palliative abdominal surgery on overall survival were assessed. We found that MF was present in 41.4%. Older age, 5-HIAA excretion ≥67 μmol/24 h, serum CgA ≥121.5 μg/L and a mesenteric mass ≥27.5 mm were independent predictors of MF. In patients ≤52 years, mesenteric mass was less often found in women than in men (39% vs 64%,P = 0.002). Corrected for age, tumour grade, CgA and liver metastasis, MF was not a prognostic factor for overall survival. In patients undergoing palliative surgery, metastasectomy of mesenteric mass or prophylactic surgery did not result in survival benefit. In conclusion, we confirmed known predictors of MF and mesenteric mass and suggest a role for sex hormones as women ≤52 years have less often a mesenteric mass. Furthermore, the presence of MF has no effect on survival in a multivariate analysis, and we found no benefit of metastasectomy of mesenteric mass or prophylactic surgery on overall survival.

scholarly journals Evolution of the Mesenteric Mass in Small Intestinal Neuroendocrine Tumours

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 443
Author(s):  
Anela Blažević ◽  
Tessa Brabander ◽  
Wouter T. Zandee ◽  
Johannes Hofland ◽  
Gaston J. H. Franssen ◽  
...  
Keyword(s):  
Neuroendocrine Tumours ◽  
Peptide Receptor Radionuclide Therapy ◽  
Size Reduction ◽  
Static Behavior ◽  
Recist 1.1 ◽  
Mesenteric Mass ◽  
Small Intestinal ◽  
Objective Size ◽  
Over Time

Background: A metastatic mesenteric mass is a hallmark of small intestinal neuroendocrine tumours (SI-NETs). However, little is known on its development over time. Therefore, we conducted a study to assess the evolution of a SI-NET-associated mesenteric mass over time. Methods: Retrospectively, 530 patients with proven SI-NET were included. The presence and growth of a mesenteric mass was assessed using RECIST 1.1 criteria on every consecutive CT-scan until the end of follow-up or resection. Results: At baseline, a mesenteric mass was present in 64% of the patients, of whom 13.5% showed growth of the mesenteric mass with a median time to growth of 40 months. Male gender was the only independent predictor of growth (OR 2.67). Of the patients without a mesenteric mass at the first evaluation, 2.6% developed a pathological mesenteric mass. Treatment with peptide receptor radionuclide therapy (PRRT; N = 132) resulted in an objective size reduction of the mesenteric mass in 3.8%. Conclusion: The metastatic mesenteric mass in SI-NETs has a static behavior over time. Therefore, site-specific growth behavior should be taken into account when selecting target lesions and assessing disease progression and therapeutic response. PRRT appears not to be effective for size reduction of the mesenteric mass.

scholarly journals The Impact of 68Gallium DOTA PET/CT in Managing Patients With Sporadic and Familial Pancreatic Neuroendocrine Tumours

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniel J. Cuthbertson ◽  
Jorge Barriuso ◽  
Angela Lamarca ◽  
Prakash Manoharan ◽  
Thomas Westwood ◽  
...  
Keyword(s):  
Functional Imaging ◽  
Neuroendocrine Tumours ◽  
Locally Advanced ◽  
Ct Imaging ◽  
Imaging Findings ◽  
Imaging Data ◽  
Cross Sectional ◽  
Pet Ct ◽  
Pancreatic Neuroendocrine Tumours ◽  
The Impact

ObjectivePancreatic neuroendocrine tumours (panNETs) arise sporadically or as part of a genetic predisposition syndrome. CT/MRI, endoscopic ultrasonography and functional imaging using Octreoscan localise and stage disease. This study aimed to evaluate the complementary role of 68Gallium (68Ga)-DOTA PET/CT in managing patients with panNETs.DesignA retrospective study conducted across three tertiary UK NET referral centres.MethodsDemographic, clinical, biochemical, cross-sectional and functional imaging data were collected from patients who had undergone a 68Ga-DOTA PET/CT scan for a suspected panNET.ResultsWe collected data for 183 patients (97 male): median (SD) age 63 (14.9) years, 89.1 vs. 9.3% (n=163 vs. 17) alive vs. dead (3 data missing), 141 sporadic vs. 42 familial (MEN1, n=36; 85.7%) panNETs. Non-functional vs. functional tumours comprised 73.2 vs. 21.3% (n=134 vs. 39) (10 missing). Histological confirmation was available in 89% of individuals (n=163) but tumour grading (Ki67 classiifcation) was technically possible only in a smaller cohort (n=143): grade 1, 50.3% (n=72); grade 2, 46.2% (n=66) and grade 3, 3.5% (n=5) (40 histopathological classification either not technically feasible or biopsy not perfomed). 60.1% (n=110) were localised, 14.2% (n=26) locally advanced and 23.5% (n=43) metastatic (4 missing). 224 68Ga-DOTA PET/CT scans were performed in total for: diagnosis/staging 40% (n=88), post-operative assessment/clinical surveillance 53% (n=117) and consideration of peptide receptor radionuclide therapy (PRRT) 8% (n=17) (2 missing). PET/CT results confirmed other imaging findings (53%), identified new disease sites (28.5%) and excluded suspected disease (5%). Overall, 68Ga-DOTA PET/CT imaging findings provided additional information in 119 (54%) patients and influenced management in 85 (39%) cases.Conclusion68Ga-DOTA PET/CT imaging more accurately stages and guides treatment in patients with sporadic/familial panNETs with newly diagnosed/recurrent disease.

scholarly journals The role of neutrophil-lymphocyte ratio as a prognostic indicator in patients undergoing nephrectomy for renal cell carcinoma

2018 ◽  
Vol 12 (7) ◽  
pp. E348-8 ◽  
Author(s):  
Nathan Grimes ◽  
Cathal Hannan ◽  
Matthew Tyson ◽  
Ali Thwaini
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Primary Tumour ◽  
Preoperative Staging ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

Introduction: Prognosis in patients with cancer is influenced by underlying tumour biology and also the host inflammatory response to the disease. There is limited evidence to suggest that an elevated neutrophil-lymphocyte ratio (NLR) predicts a poorer prognosis in patients undergoing nephrectomy for renal cell carcinoma (RCC). The aim of this paper is to investigate if patients undergoing nephrectomy for RCC with NLR ≤4 have a better overall and recurrence-free survival than patients with NLR >4.Methods: All patients who underwent nephrectomy at a single centre between January 1, 2011 and December 31, 2014 were identified. Patients were included if postoperative histology demonstrated RCC and if preoperative NLR was available. Patients were excluded if nephrectomy was not curative intent (i.e., cytoreductive nephrectomy), if primary tumour was graded to be T3b‒4 disease, if there was presence of nodal or metastatic disease on preoperative staging, or if adequate followup notes were not available. Primary and secondary outcomes were overall survival and recurrence-free survival, respectively.Results: A total of 154 patients were included in analysis of overall survival; 146 patients were included in analysis of recurrence-free survival. Patients with NLR ≤4 had a much better overall survival than patients with NLR >4 (95% vs. 78%; p=0.0219). Patients with NLR >4 also had higher rates of recurrence (p=0.0218).Conclusions: NLR may be a useful tool in identifying patients who may benefit from more frequent surveillance in the early postoperative period and may allow clinicians to offer surveillance schemes tailored to the individual patient.

scholarly journals Molecular prognostic factors in small-intestinal neuroendocrine tumours

2019 ◽  
Vol 8 (7) ◽  
pp. 906-922 ◽  
Author(s):  
K G Samsom ◽  
L M van Veenendaal ◽  
G D Valk ◽  
M R Vriens ◽  
M E T Tesselaar ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Loss Of Heterozygosity ◽  
Clinical Decision Making ◽  
Neuroendocrine Tumours ◽  
International Studies ◽  
Precision Oncology ◽  
Chromosome 18 ◽  
Genomic Aberration ◽  
Rare Tumours ◽  
Small Intestinal

Background Small-intestinal neuroendocrine tumours (SI-NETs) represent a heterogeneous group of rare tumours. In recent years, basic research in SI-NETs has attempted to unravel the molecular events underlying SI-NET tumorigenesis. Aim We aim to provide an overview of the current literature regarding prognostic and predictive molecular factors in patients with SI-NETs. Method A PubMed search was conducted on (epi)genetic prognostic factors in SI-NETs from 2000 until 2019. Results The search yielded 1522 articles of which 20 reviews and 35 original studies were selected for further evaluation. SI-NETs are mutationally quiet tumours with a different genetic make-up compared to pancreatic NETs. Loss of heterozygosity at chromosome 18 is the most frequent genomic aberration (44–100%) followed by mutations of CDKN1B in 8%. Prognostic analyses were performed in 16 studies, of which 8 found a significant (epi)genetic association for survival or progression. Loss of heterozygosity at chromosome 18, gains of chromosome 4, 5, 7, 14 and 20p, copy gain of the SRC gene and low expression of RASSF1A and P16 were associated with poorer survival. In comparison with genetic mutations, epigenetic alterations are significantly more common in SI-NETs and may represent more promising targets in the treatment of SI-NETs. Conclusion SI-NETs are mutationally silent tumours. No biomarkers have been identified yet that can easily be adopted into current clinical decision making. SI-NETs may represent a heterogeneous disease and larger international studies are warranted to translate molecular findings into precision oncology.

scholarly journals A Clinicopathological Analysis on Diffuse Midline Glioma in Adults

2021 ◽  
Author(s):  
Xiao Mu Hu ◽  
Xiao Yu Nie ◽  
Kai Lun Xu ◽  
Yin Wang ◽  
Feng Tang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Age Groups ◽  
Young Patients ◽  
Imaging Data ◽  
Wild Type ◽  
Old Patients ◽  
Diffuse Midline Glioma

Abstract Purpose: Diffuse midline glioma (DMG), H3K27M mutant is a new entity that has become widely recognized. However, studies concerning DMG in adult patients remains rare. We did a retrospective study covering the largest amount of patients to date to analyze the clinicopathological characteristics of DMG in adult. Methods: We reviewed 117 cases of adult DMG, collected their clinical and imaging data along with pathological results including H3K27M. Summarized their features and the connection with overall survival in different age groups.Results: Among 117 cases, most tumors were located at the thalamus, 39 patients had H3K27M mutation, of whom 38 demonstrated down regulation of H3K27me3. The average overall survival of H3K27M-mutant gliomas was 13 months, while that of 78 H3K27M wild-type gliomas were 11.8 months. For young patients (age＜35), The median survival time of the H3K27M-mutant was 20.1 months, while that of the H3K27M wild-type was 39.5 months. For older patients (age≥35), the median survival time of the H3K27M-mutant was 22.3 months, while that of the H3K27M wild-type was 17.1 months. The OS of patients who received biopsies, subtotal resections, and total resections were 15.8, 17.6, and 11.6 months respectively. Conclusion: The DMG in adults mainly occurred in the thalamus. H3K27M mutations tend to happen more frequently in young adults, and this genetic alteration results in a worse outcome only in young patients. For old patients, age and the approach of surgery are independent prognostic factors. Patients received biopsy instead of total resection had a better prognosis.

scholarly journals Establishment and validation of pre-therapy cervical vertebrae muscle quantification as a prognostic marker of sarcopenia in head and neck patients receiving definitive cancer surgery

2021 ◽  
Author(s):  
Brennan Olson ◽  
Jared Edwards ◽  
Catherine Degnin ◽  
Nicole Santucci ◽  
Michelle Buncke ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Overall Survival ◽  
Head And Neck ◽  
Cervical Vertebrae ◽  
Ct Imaging ◽  
Primary Study ◽  
Muscle Area ◽  
Cross Sectional ◽  
Men And Women ◽  
Muscle Cross Sectional Area

Importance: Sarcopenia, or diminished skeletal muscle mass, is prognostic for survival in patients with head and neck cancer (HNC). However, identification of this high-risk feature remains challenging for patients without computed tomography (CT) images that capture the abdomen or lower thorax. Objectives: To (1) define sarcopenia thresholds at the C3 vertebral level using previously established thresholds derived from abdominal CT imaging and (2) determine if C3-defined sarcopenia is associated with survival in patients with HNC. Design, setting, and participants: This retrospective cohort study was conducted in consecutive patients with a squamous cell carcinoma of the head and neck with cross-sectional abdominal or neck imaging within 60 days prior to treatment and treated between January 2005 and December 2017. Data analysis was completed from December 2018 to April 2021. Exposures: Measurement of the cross-sectional muscle area at the third lumbar and cervical vertebral levels using CT imaging. Main outcomes and measures: Primary study outcome was overall survival. Results: In a cohort of 253 HNC patients with CT imaging that captures both L3 and C3 vertebral levels, skeletal muscle cross-sectional area at C3 was strongly correlated with the L3 level in both men (n = 188; r = 0.77; p < 0.001) and women (n = 65; r = 0.80; p < 0.001), and C3-defined sarcopenia thresholds of 14.0 cm2/m2 (men) and 11.1 cm2/m2 (women) were best predictive of previously established L3-defined sarcopenia thresholds. Applying these defined C3 sarcopenia thresholds in a cohort of 536 HNC patients with neck imaging alone revealed that C3-defined sarcopenia was independently associated with reduced overall survival in men (HR = 2.63; 95% CI, 1.79, 3.85) but not women (HR = 1.18, 95% CI, 0.76, 1.85) with HNC. Conclusions and relevance: This study identifies sarcopenia thresholds at the C3 level that best predict L3-defined sarcopenia in both men and women. In HNC, C3-defined sarcopenia is associated with poor survival outcomes in men, but not women, suggesting sarcopenia may differentially affect men and women with HNC.

scholarly journals Survival and Disease Recurrence in Patients with Duodenal Neuroendocrine Tumours—A Single Centre Cohort

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 3985
Author(s):  
Oddry Folkestad ◽  
Hans H. Wasmuth ◽  
Patricia Mjønes ◽  
Reidun Fougner ◽  
Øyvind Hauso ◽  
...  
Keyword(s):  
Overall Survival ◽  
Recurrence Rate ◽  
Surgical Resection ◽  
Endoscopic Treatment ◽  
Neuroendocrine Tumours ◽  
Disease Recurrence ◽  
Tumour Grade ◽  
Single Centre ◽  
Duodenal Neuroendocrine Tumours

Background: Duodenal neuroendocrine tumours (D-NETs) are rare but increasingly diagnosed. This study aimed to assess the overall survival and recurrence rate among patients treated for D-NETs. Methods: Patients with D-NETs were retrospectively reviewed with a median follow-up time of 4.8 years (range 0.0–17.2 years). Results: A total of 32 patients with median age 68.0 years were identified. Fifteen patients underwent surgery while ten patients underwent endoscopic treatment. Mean estimated overall survival for the entire population was 12.1 years (95% CI 9.5–14.7 years), while 5-year overall survival was 81.3%. Tumour grade G1 was associated with longer mean estimated survival compared to G2 tumours (13.2 years versus 4.4 years, p = 0.010). None of the 23 patients who underwent presumed radical endoscopic or surgical resection had disease recurrence during follow-up. Tumours <10 mm could be treated endoscopically whereas a high proportion of patients with tumours 10–20 mm should be considered for surgery. Conclusion: Patients with D-NETs had long overall survival, and mortality was more influenced by other diseases. Both endoscopic and surgical resections were effective as no recurrences were diagnosed during follow-up.

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