Exploration of Novel Prognostic Markers in Grade 3 Neuroendocrine Neoplasia
Background: High-grade neuroendocrine tumours and carcinomas (NET/NECs) behave aggressively, typically presenting at an advanced stage. Prognosis is poor, with median survival between 5 and 34 months. The mainstay of treatment is palliative systemic therapy. However, therapy carries a risk of toxici...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-08-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/16/4232 |
| _version_ | 1797524385819525120 |
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| author | Rebecca Abdelmalak Mark P. Lythgoe Joanne Evans Michael Flynn Justin Waters Andy Webb David J. Pinato Rohini Sharma |
| author_facet | Rebecca Abdelmalak Mark P. Lythgoe Joanne Evans Michael Flynn Justin Waters Andy Webb David J. Pinato Rohini Sharma |
| author_sort | Rebecca Abdelmalak |
| collection | DOAJ |
| description | Background: High-grade neuroendocrine tumours and carcinomas (NET/NECs) behave aggressively, typically presenting at an advanced stage. Prognosis is poor, with median survival between 5 and 34 months. The mainstay of treatment is palliative systemic therapy. However, therapy carries a risk of toxicity, which can reduce quality of life. Therefore, accurate prognostic scores for risk stratification of patients with high-grade NET/NECs are needed to help guide patient management to decide whether active treatment is likely to improve overall survival (OS). We aimed to compare the prognostic ability of published prognostic scores to predict OS in a cohort of patients with high-grade NET/NECs of any primary site. Methods: Treatment, biochemical and clinicopathological data were collected retrospectively from 77 patients with high-grade NET/NECs across three hospitals between 2016 and 2020. Variables including performance status (PS), Ki-67, age at diagnosis, previous treatment and presence of liver metastases were recorded. Pre-treatment neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, modified Glasgow prognostic score (mGPS), and gastrointestinal neuroendocrine carcinoma (GI-NEC) score were derived. Univariable and multivariable survival analyses were used to assess prognostic ability. Results: The median age of the cohort was 63 years (range: 31–85); 53% of subjects were female. Grade 3 NETs (G3-NETs) were identified in 32 patients and NECs in 45 patients. The median OS was 13.45 months (range: 0.87–65.37) with no difference observed between G3-NETs and NECs. Univariable analysis revealed that NLR (<i>n</i> = 72, <i>p</i> = 0.049), mGPS (<i>n</i> = 56, <i>p</i> = 0.003), GI-NEC score (<i>n</i> = 27, <i>p</i> = 0.0007) and Ki-67 (<i>n</i> = 66, <i>p</i> = 0.007) were significantly associated with OS. Multivariable analysis confirmed that elevated mGPS (<i>p</i> = 0.046), GI-NEC score (<i>p</i> = 0.036), and Ki-67 (<i>p</i> = 0.02) were independently prognostic for reduced OS across the entire cohort. mGPS was identified as an independent prognostic factor in G3-NETs. Independent predictors of OS in NECs were PS and Ki-67. Conclusions: mGPS, PS and Ki-67 are independent prognostic markers in high-grade NET/NEC patients. Our study supports the use of these prognostic scores for risk stratification of patients with high grade cancers and as useful tools to guide treatment decisions. |
| first_indexed | 2024-03-10T08:56:36Z |
| format | Article |
| id | doaj.art-7e4dabd399b54bfd8e9ac08866961c48 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T08:56:36Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-7e4dabd399b54bfd8e9ac08866961c482023-11-22T07:05:46ZengMDPI AGCancers2072-66942021-08-011316423210.3390/cancers13164232Exploration of Novel Prognostic Markers in Grade 3 Neuroendocrine NeoplasiaRebecca Abdelmalak0Mark P. Lythgoe1Joanne Evans2Michael Flynn3Justin Waters4Andy Webb5David J. Pinato6Rohini Sharma7Division of Surgery and Cancer, Hammersmith Hospital, Imperial College London, Du Cane Road 72, London W12 0HS, UKDivision of Surgery and Cancer, Hammersmith Hospital, Imperial College London, Du Cane Road 72, London W12 0HS, UKDivision of Surgery and Cancer, Hammersmith Hospital, Imperial College London, Du Cane Road 72, London W12 0HS, UKDepartment of Medical Oncology, University College London Hospital, London WC1E 6BT, UKKent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Canterbury CT1 3NG, UKDepartment of Oncology, Brighton and Sussex University Hospitals, Brighton BN2 5BE, UKDivision of Surgery and Cancer, Hammersmith Hospital, Imperial College London, Du Cane Road 72, London W12 0HS, UKDivision of Surgery and Cancer, Hammersmith Hospital, Imperial College London, Du Cane Road 72, London W12 0HS, UKBackground: High-grade neuroendocrine tumours and carcinomas (NET/NECs) behave aggressively, typically presenting at an advanced stage. Prognosis is poor, with median survival between 5 and 34 months. The mainstay of treatment is palliative systemic therapy. However, therapy carries a risk of toxicity, which can reduce quality of life. Therefore, accurate prognostic scores for risk stratification of patients with high-grade NET/NECs are needed to help guide patient management to decide whether active treatment is likely to improve overall survival (OS). We aimed to compare the prognostic ability of published prognostic scores to predict OS in a cohort of patients with high-grade NET/NECs of any primary site. Methods: Treatment, biochemical and clinicopathological data were collected retrospectively from 77 patients with high-grade NET/NECs across three hospitals between 2016 and 2020. Variables including performance status (PS), Ki-67, age at diagnosis, previous treatment and presence of liver metastases were recorded. Pre-treatment neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, modified Glasgow prognostic score (mGPS), and gastrointestinal neuroendocrine carcinoma (GI-NEC) score were derived. Univariable and multivariable survival analyses were used to assess prognostic ability. Results: The median age of the cohort was 63 years (range: 31–85); 53% of subjects were female. Grade 3 NETs (G3-NETs) were identified in 32 patients and NECs in 45 patients. The median OS was 13.45 months (range: 0.87–65.37) with no difference observed between G3-NETs and NECs. Univariable analysis revealed that NLR (<i>n</i> = 72, <i>p</i> = 0.049), mGPS (<i>n</i> = 56, <i>p</i> = 0.003), GI-NEC score (<i>n</i> = 27, <i>p</i> = 0.0007) and Ki-67 (<i>n</i> = 66, <i>p</i> = 0.007) were significantly associated with OS. Multivariable analysis confirmed that elevated mGPS (<i>p</i> = 0.046), GI-NEC score (<i>p</i> = 0.036), and Ki-67 (<i>p</i> = 0.02) were independently prognostic for reduced OS across the entire cohort. mGPS was identified as an independent prognostic factor in G3-NETs. Independent predictors of OS in NECs were PS and Ki-67. Conclusions: mGPS, PS and Ki-67 are independent prognostic markers in high-grade NET/NEC patients. Our study supports the use of these prognostic scores for risk stratification of patients with high grade cancers and as useful tools to guide treatment decisions.https://www.mdpi.com/2072-6694/13/16/4232prognosisneuroendocrine tumoursinflammationsurvival |
| spellingShingle | Rebecca Abdelmalak Mark P. Lythgoe Joanne Evans Michael Flynn Justin Waters Andy Webb David J. Pinato Rohini Sharma Exploration of Novel Prognostic Markers in Grade 3 Neuroendocrine Neoplasia Cancers prognosis neuroendocrine tumours inflammation survival |
| title | Exploration of Novel Prognostic Markers in Grade 3 Neuroendocrine Neoplasia |
| title_full | Exploration of Novel Prognostic Markers in Grade 3 Neuroendocrine Neoplasia |
| title_fullStr | Exploration of Novel Prognostic Markers in Grade 3 Neuroendocrine Neoplasia |
| title_full_unstemmed | Exploration of Novel Prognostic Markers in Grade 3 Neuroendocrine Neoplasia |
| title_short | Exploration of Novel Prognostic Markers in Grade 3 Neuroendocrine Neoplasia |
| title_sort | exploration of novel prognostic markers in grade 3 neuroendocrine neoplasia |
| topic | prognosis neuroendocrine tumours inflammation survival |
| url | https://www.mdpi.com/2072-6694/13/16/4232 |
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