Prognostic Factor Analysis in Grade 3 Gastroenteropancreatic Neuroendocrine Neoplasms

2020 Year in Review - Neuroendocrine Tumors

A retrospective analysis of a large database of grade 3 gastroenteropancreatic (GEP) neuroendocrine carcinomas (NECs) identified clinically relevant prognostic factors that could potentially inform clinical decisions in this setting.

Given the aggressiveness of grade 3 neuroendocrine carcinomas (NECs) and limited treatment options available, an analysis was conducted to identify prognostic factors in a large cohort of grade 3 GEP-NECs from the Spanish National Neuroendocrine Cancer Registry of GEP-neuroendocrine neoplasms (NENs) that is coordinated by the Grupo Español de Tumores Neuroendocrinos y Endocrinos (R-GETNE). Results of this retrospective analysis were reported at the European Society for Medical Oncology Virtual Congress 2020.

The R-GETNE database includes 4807 patients with GEP-NENs diagnosed between 2004 and 2019. Of these, 535 patients had grade 3 NECs that were poorly differentiated and had a Ki67 index >20%. The median age of the study cohort was 64 years, with 29% aged ≥70 years; 60% were male and 85% of patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 to 1. The most common primary sites were colorectum (30%), pancreas (24%), unknown (16%), stomach (13%), and small intestine (4%). The majority of patients presented with stage IV disease at diagnosis (68%), 3% with stage I, 9% with stage II, and 20% with stage III. In terms of treatment modalities, 87% of patients with stage I to stage III NECs underwent surgical resection, of whom 54% received adjuvant chemotherapy. Chemotherapy primarily consisted of platinum and etoposide (73%) for patients with advanced NECs, achieving a response rate of 64% and a median progression-free survival of 6.1 months.

At a median follow-up of 4 years with 353 patient (67%) deaths, the median overall survival (OS) was 14 months. Median OS was 6.1 years (95% confidence interval [CI], 1.8-not applicable [NA]) for patients with stage I disease, 5.8 years (95% CI, 1.9-NA) for stage II, 2.1 years (95% CI, 1.5-6.7) for stage III, and 9.7 months (95% CI, 6.7-12.9) for stage IV disease. Among patients with stage IV disease, OS by metastatic site was 14.0 months (95% CI, 12.6-15.8) for small intestine, 10.1 months (95% CI, 9.5-11.8) for pancreas, 9.9 months (95% CI, 8.2-11.2) for rectum, 7.3 months (95% CI, 5.2-9.3) for stomach, 4.7 months (95% CI, 2.8-7.0) for colon, and 2.7 months (95% CI, 1.9-3.8) for unknown primary. Multivariate analysis showed several independent prognostic factors for OS (P <.05), including stage (I-III vs IV; hazard ratio [HR], 0.43; 95% CI, 0.27-0.81), primary site (small intestine, pancreas, and rectum vs others; HR, 0.63; 95% CI, 0.44-0.92), ECOG PS (0-1 vs 2; HR, 0.64; 95% CI, 0.37-0.77), and sex (female vs male; HR, 0.89; 95% CI, 0.74-0.95).

These data identify clinically relevant clinical factors with significant prognostic value that could aid in making clinical decisions for patients with grade 3 GEP-NENs.

Source: Fonseca PJ, et al. Ann Oncol. 2020;31(suppl 4). Abstract 1159MO.

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