Sara Massironi1, Davide Campana2, Stefano Partelli3, Francesco Panzuto4, Roberta Elisa Rossi5, Antongiulio Faggiano6, Nicole Brighi2, Massimo Falconi3, Maria Rinzivillo4, Gianfranco Delle Fave4, Anna Maria Colao6, Dario Conte5. 1. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. sara.massironi@policlinico.mi.it. 2. Department of Medical and Surgical Sciences, Bologna University St. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy. 3. Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy. 4. Digestive and Liver Diseases Department, University "La Sapienza" of Rome Sant'Andrea Hospital, Rome, Italy. 5. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. 6. Division of Endocrinology, Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
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.
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.
Authors: Catherine G Tran; Scott K Sherman; Mohammed O Suraju; Apoorve Nayyar; Henning Gerke; Rami G El Abiad; Chandrikha Chandrasekharan; Po Hien Ear; Thomas M O'Dorisio; Joseph S Dillon; Andrew M Bellizzi; James R Howe Journal: Ann Surg Oncol Date: 2021-09-13 Impact factor: 5.344
Authors: Adriana C Gamboa; Yuan Liu; Rachel M Lee; Mohammad Y Zaidi; Charles A Staley; David A Kooby; Joshua H Winer; Mihir M Shah; Maria C Russell; Kenneth Cardona; Shishir K Maithel Journal: J Surg Oncol Date: 2019-10-16 Impact factor: 3.454
Authors: R E Rossi; A C Milanetto; V Andreasi; D Campana; J Coppa; G Nappo; M Rinzivillo; P Invernizzi; R Modica; A David; S Partelli; G Lamberti; V Mazzaferro; A Zerbi; F Panzuto; C Pasquali; M Falconi; S Massironi Journal: J Endocrinol Invest Date: 2021-03-02 Impact factor: 4.256
Authors: Roberta Elisa Rossi; Alessandra Elvevi; Camilla Gallo; Andrea Palermo; Pietro Invernizzi; Sara Massironi Journal: World J Gastroenterol Date: 2022-07-14 Impact factor: 5.374