ΑΠΟΤΕΛΕΣΜΑΤΑ ΕΥΡΗΜΑΤΩΝ ΜΗΤΡΩΟΥ NETS
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Transcript of ΑΠΟΤΕΛΕΣΜΑΤΑ ΕΥΡΗΜΑΤΩΝ ΜΗΤΡΩΟΥ NETS
ΑΠΟΤΕΛΕΣΜΑΤΑ ΕΥΡΗΜΑΤΩΝ ΜΗΤΡΩΟΥ NETSΆννα Κουμαριανού M.D Ph.D.
Παθολόγος ΟγκολόγοςΔ΄ Παθολογική Κλινική
ΓΠΝΑ ΄Αττικόν΄
N (%) Total 246 (100) Gender Female 125 (50.8) Male 121 (49.2) Median age at diagnosis Total 57 (18-82) Female 58 (18-79) Male 55 (21-82) Clinical Symptoms p=0.455Female 27 (21.6%) Male 32 (26.4%) Total 59 (24%) Incidental Diagnosis P=0.168Female 44 (35.2) Male 32 (26.4) Total 76 (30.9) Referral by another specialty P=0.608Female 54 (43.2) Male 57 (47.1) Total 111 (45.1)
ΔΗΜΟΓΡΑΦΙΚΑ ΚΑΙ ΚΛΙΝΙΚΟΠΑΘΟΛΟΓΙΚΑ ΧΑΡΑΚΤΗΡΙΣΤΙΚΑ
Primary site No of patientsGastrenteropancreatic 156 (63.4)
Stomach 54 (35%)Antrum 11 (20.4)Fundus 6 (11.1)Corpus 37 (68.5)Antrum 11 (20.4)
Pancreas 36 (23%)Head 20 (55.6)
Tail 10 (27.8)Body 6 (16.7)
Duodenum 8 (5%)Jejunum 5 (3%)Ileum 10 (6%)Appendix 17 (11%)Colon 8 (5%)Rectum 18 (12%)
Head and Neck 44 (17.9)Pheochromocytoma 6 (2.4)Lung 16 (6.5)
Typical 10 (62.5)Atypical 6 (37.5)
Unknown Primary 24 (9.8)Differentiation Grade† Well 132 (58.4)Moderate 73 (32.3)Poor 21 (9.3)Ki-67 LI‡ No of patients<2% 1662-20% 56>20% 6
Diagnostic procedures
PerformedN (%)
Positive yield N (%)
Computed Tomography 202 (82.1) 117 (58.5)
Octreoscan 156 (63.4) 79 (50.6)Chest x-ray 152 (61.8) 20 (13.2)Gastroscopy 126 (51.2) 65 (51.6)Abdominal ultrasound 90 (36.6) 50 (55.6)Colonoscopy 90 (36.6) 27 (30.0)Magnetic Resonance 85 (34.6) 63 (75.0)Bone Scan 59 (24.0) 12 (20.7)Endoscopic Ultrasound 27 (11.0) 20 (74.1)Endoscopic capsule 16 (6.5) 3 (18.8)PET 11 (4.5) 9 (81.8)MIBG 10 (4.1) 6 (60.0)Bronchoscopy 10 (4.1) 7 (70.0)Enteroclysis 5 (2.0) 3 (60.0)
Most common diagnostic procedures and yield of tumor detection
Diagnostic Procedure Head & Neck
n (%)
Bronchial n (%)
GEP n (%)
Pheochromocytoma
n (%)
Unknown Primary
n (%)
p
Octreoscan 5 (31.3) 5 (45.5) 59 (55.1) 1 (50.0) 7 (35.0) 0.219
MIBG 1 (100.0) 0 (0) 0 (0.0) 1 (20.0) 2 (66.7) 0.429Computed Tomography 7 (21.2) 1 (6.3) 71 (56.8) 0 (0) 4 (18.2) <0.001
Magnetic Resonance 2 (18.2) 0 (0) 16 (30.8) 0 (0) 3 (21.4) 0.651
PET 0 (0) 0 (0) 1 (33.3) 0 (0) 1 (100.0) 0.182x-Ray 33 (100.0) 0 (0) 82 (97.6) 2 (100.0) 14 (82.4) <0.001
Bone Scan 18 (81.8) 9 (75.0) 7 (77.8) 3 (75.0) 9 (81.8) 0.985Abdominal Ultrasound 5 (100.0) 2 (66.7) 32 (49.2) 0 (0) 1 (7.7) <0.001
Gastroscopy 4 (100.0) 3 (100.0) 42 (40.0) 0 (0) 12 (85.7) <0.001
Colonoscopy 2 (100.0) 2 (100.0) 44 (62.0) 0 (0) 15 (100.0) 0.003
Endoscopic Capsule 0 (0) 0 (0) 7 (70.0) 0 (0) 6 (100.0) 0.250Enteroclysis 0 (0) 0 (0) 1 (25.0) 0 (0) 1 (100.0) 0.400
Endoscopic Ultrasound 1 (100.0) 0 (0) 4 (19.0) 0 (0) 2 (40.0) 0.220
Bronchoscopy 0 (0) 0 (0) 0 (0) 0 (0) 3 (100.0) 0.008
Rate of positive results according to diagnostic procedures used for staging according to primary site
Immunohistochemistry grading and Ki-67 labeling index in relation to primary site
CLINICOPATHOLOGIC
FEATURES
Head &Neck n (%)
Bronchial n (%)
GEP n (%)
Pheochromocytoma n (%)
Unknown Primary
n (%)
Total n (%)
Vascular invasion 13 (29.5) 5 (38.5) 23 (16.7) 2 (33.3) 3 (42.9) 46 (22.1)
Local infiltration 22 (50.0)
6 (40.0)
55 (38.7)
2 (33.3)
5 (55.6)
90 (41.7)
G1 22 10 84 4 12 132
G2 18 6 42 2 5 73
G3 1 0 17 0 3 21
Distribution of Ki-67 labelling index according to gender, stage, type of treatment, responses and deaths
PARAMETERS Ki-67 Labeling Index p
Gender <2 (166 cases) 2-20 (56 cases) >20 (6 cases)
Male 82 (74.5) 24 (21.8) 4 (3.6) 0.488
Female 84 (71.2) 32 (27.1) 2(1.7)
Stage TNM
Τ0 16 (84.2) 3 (15.8) 0 (0) <0.001
Τ1 68 (82.9) 14 (17.1) 0 (0)
Τ2 16 (64.0) 9 (36.0) 0 (0)
Τ3 17 (54.8) 11 (35.5) 3 (9.7)
Τ4 4 (28.6) 10 (71.4) 0 (0)
ΤΧ 45 (78.9) 9 (15.8) 3 (5.3)
Ν0 111 (78.2) 30 (21.1) 1 (0.7) 0.020
Ν1 39 (60.9) 20 (31.3) 5 (7.8)
ΝΧ 16 (72.7) 6 (27.3) 0 (0)
Μ0 97 (81.5) 22 (18.5) 0 (0) <0.001
Μ1 29 (52.7) 21 (38.2) 5 (9.1)
ΜΧ 40 (74.1) 13 (24.1) 1 (1.9)
Sunitinib 5 5
Everolimus 3 2
Chemotherapy 11 9 2
Responses to Chemo (1
unknown Ki-67, 2
unknown responses)
PR 2 3 1
SD 5 5 1
PD 4 1 0
Lanreotide 52 20 3
Octreotide 85 33 1
Total Number of
patients treated
with SA
135 (13 H&N, 10
lung, 95GEP, 16UP
&1Pheo)
Responses to SSA §
(11 missing cases)
PR 36 11 0
SD 89 14 3
PD 5 4 1 10
Progression free on
SSA (number of patients)
Yes 125 44 3
No 5 4 1
Death 7 (70.0) 1 (10.0) 2 (20.0) 0.012
(18 cases are missing) PR partial response, SD stable disease, PD progressive disease §equal response
rates between lanreotide and octreotide were observed.
Distribution of Ki-67 labelling index according to type of treatment & responses
Primary Surgical Excision¥ Radical Non RadicalHead and Neck 40 4Lung 8 2GEP 110 20Pheochromocytoma 4 2Unknown Primary 2 1
Type of Surgery Total number of patients Open Surgery 128
Endoscopic/Laparoscopic Excision 65 Number of patients with liver metastases 49 1 pheo,3 lung, 11UP, 34GEP
Treatment of Liver Metastases Number of patients Primary (all Ki67<20%)
Liver Metastasectomy 6 1 Lung, 4GEP, 1 UP
Chemoembolization 3 GEPRadiofrequency Ablation 4 GEP
Other 2 GEPNumber of patients with lung metastases 6 1lung, 1UP, 4GEP
Treatment of Lung Metastases 1 surgical excision 1lung
Primary surgery and debulking procedures in NET patients
Distribution of Ki-67 labelling index according to the primary site of NET tumors (WHO classification, 18 missing cases)
The researchers thank IPSEN EPE!
I thank you for your attention!