Management of neuroendocrine neoplasms: conformity with guidelines in and outside a center of excellence
Purpose: To improve neuroendocrine neoplasm (NEN) management, the European Neuroendocrine Tumor Society (ENETS) recognised 62 Centers of Excellence (CoE). This retrospective study compares conformity of patients’ initial management within vs outside an ENETS CoE with clinical practice guidelines (CP...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Bioscientifica
2022-06-01
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| Series: | Endocrine Connections |
| Subjects: | |
| Online Access: | https://ec.bioscientifica.com/view/journals/ec/11/6/EC-22-0097.xml |
| _version_ | 1811332483951624192 |
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| author | Carole Morin Keo-Morakort Benedetto Agathe Deville Laurent Milot Aurélie Theillaumas Valérie Hervieu Mathieu Pioche Gilles Poncet Julien Forestier Laurent François Francoise Borson-Chazot Mustapha Adham Catherine Lombard-Bohas Thomas Walter |
| author_facet | Carole Morin Keo-Morakort Benedetto Agathe Deville Laurent Milot Aurélie Theillaumas Valérie Hervieu Mathieu Pioche Gilles Poncet Julien Forestier Laurent François Francoise Borson-Chazot Mustapha Adham Catherine Lombard-Bohas Thomas Walter |
| author_sort | Carole Morin |
| collection | DOAJ |
| description | Purpose: To improve neuroendocrine neoplasm (NEN) management, the European Neuroendocrine Tumor Society (ENETS) recognised 62 Centers of Excellence (CoE). This retrospective study compares conformity of patients’ initial management within vs outside an ENETS CoE with clinical practice guidelines (CPGs).
Methods: Patients diagnosed with a NEN between August 2018 and July 2020 and presented in the Lyon-CoE Multidisciplinary Tumour Board (MDT) were included. Factors potentially associated with the conformity of initial management (work-up and first treatment) to CPG underwent univariate and multivariate analyses.
Results: Among the 615 included patients, 170 (27.6%) were initially managed in the CoE and 445 (72.4%) were only presented at the CoE-MDT. Patients in the CoE group more often had intestinal or pancreatic primaries, metastatic disease (61.8% vs 33%), hereditary syndrome, and a functioning tumour. Work-up conformity was 37.1% in the CoE (vs 29.9%, P = 0.09); this was 95.8% for the first treatment (vs 88.7%, P = 0.01). After multivariate analysis, CPG conformity was significantly higher for patients managed in the CoE, for younger patients, for those having a grade 1–2 tumour, and a genetic syndrome. Pancreatic and small intestinal (SI) NET surgeries performed in the CoE had a higher splenic preservation rate during left pancreatectomy, better detection of multiple tumours in SI surgeries, and higher number of resected lymph nodes.
Conclusions: Given the widespread observance of CPG, not all patients require management in the CoE. Referral should be considered for more complex cases such as metastatic diseases, G2 tumours, or carcinoid syndromes. Finally, we should encourage the centralization of NET surgery. |
| first_indexed | 2024-04-13T16:37:39Z |
| format | Article |
| id | doaj.art-f1cee055f6674d02bee186721fd5a5ed |
| institution | Directory Open Access Journal |
| issn | 2049-3614 |
| language | English |
| last_indexed | 2024-04-13T16:37:39Z |
| publishDate | 2022-06-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrine Connections |
| spelling | doaj.art-f1cee055f6674d02bee186721fd5a5ed2022-12-22T02:39:23ZengBioscientificaEndocrine Connections2049-36142022-06-01116112https://doi.org/10.1530/EC-22-0097Management of neuroendocrine neoplasms: conformity with guidelines in and outside a center of excellenceCarole Morin0Keo-Morakort Benedetto1Agathe Deville2Laurent Milot3Aurélie Theillaumas4Valérie Hervieu5Mathieu Pioche6Gilles Poncet7Julien Forestier8Laurent François9Francoise Borson-Chazot10Mustapha Adham11Catherine Lombard-Bohas12Thomas Walter13Hospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, FranceHospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, FranceHospices Civils de Lyon, Hôpital Louis Pradel, Médecine Nucléaire, Bron, France; Centre de Recherche en Cancérologie de Lyon, UMR Inserm 1052 CNRS 5286, Lyon Cedex 08, FranceHospices Civils de Lyon, Hôpital Edouard Herriot, Radiologie, Lyon Cedex 03, France; University of Lyon, Université Lyon 1, FranceHospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, FranceCentre de Recherche en Cancérologie de Lyon, UMR Inserm 1052 CNRS 5286, Lyon Cedex 08, France; University of Lyon, Université Lyon 1, France; Hospices Civils de Lyon, Institut de Pathologie Est, Bron Cedex, France University of Lyon, Université Lyon 1, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Gastroentérologie, Lyon Cedex 03, FranceCentre de Recherche en Cancérologie de Lyon, UMR Inserm 1052 CNRS 5286, Lyon Cedex 08, France; University of Lyon, Université Lyon 1, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Chirurgie Digestive, Lyon Cedex 03, France Hospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, FranceHospices Civils de Lyon, Hôpital Louis Pradel, Exploration Fonctionnelle, Bron Cedex, FranceUniversity of Lyon, Université Lyon 1, France; Hospices Civils de Lyon, Hôpital Louis Pradel, Endocrinologie, Bron Cedex, FranceUniversity of Lyon, Université Lyon 1, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Chirurgie Digestive, Lyon Cedex 03, FranceHospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, FranceHospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, France; Centre de Recherche en Cancérologie de Lyon, UMR Inserm 1052 CNRS 5286, Lyon Cedex 08, France; University of Lyon, Université Lyon 1, France Purpose: To improve neuroendocrine neoplasm (NEN) management, the European Neuroendocrine Tumor Society (ENETS) recognised 62 Centers of Excellence (CoE). This retrospective study compares conformity of patients’ initial management within vs outside an ENETS CoE with clinical practice guidelines (CPGs). Methods: Patients diagnosed with a NEN between August 2018 and July 2020 and presented in the Lyon-CoE Multidisciplinary Tumour Board (MDT) were included. Factors potentially associated with the conformity of initial management (work-up and first treatment) to CPG underwent univariate and multivariate analyses. Results: Among the 615 included patients, 170 (27.6%) were initially managed in the CoE and 445 (72.4%) were only presented at the CoE-MDT. Patients in the CoE group more often had intestinal or pancreatic primaries, metastatic disease (61.8% vs 33%), hereditary syndrome, and a functioning tumour. Work-up conformity was 37.1% in the CoE (vs 29.9%, P = 0.09); this was 95.8% for the first treatment (vs 88.7%, P = 0.01). After multivariate analysis, CPG conformity was significantly higher for patients managed in the CoE, for younger patients, for those having a grade 1–2 tumour, and a genetic syndrome. Pancreatic and small intestinal (SI) NET surgeries performed in the CoE had a higher splenic preservation rate during left pancreatectomy, better detection of multiple tumours in SI surgeries, and higher number of resected lymph nodes. Conclusions: Given the widespread observance of CPG, not all patients require management in the CoE. Referral should be considered for more complex cases such as metastatic diseases, G2 tumours, or carcinoid syndromes. Finally, we should encourage the centralization of NET surgery.https://ec.bioscientifica.com/view/journals/ec/11/6/EC-22-0097.xmlneuroendocrine neoplasmenets center of excellencediagnostic managementconformity to clinical guidelines |
| spellingShingle | Carole Morin Keo-Morakort Benedetto Agathe Deville Laurent Milot Aurélie Theillaumas Valérie Hervieu Mathieu Pioche Gilles Poncet Julien Forestier Laurent François Francoise Borson-Chazot Mustapha Adham Catherine Lombard-Bohas Thomas Walter Management of neuroendocrine neoplasms: conformity with guidelines in and outside a center of excellence Endocrine Connections neuroendocrine neoplasm enets center of excellence diagnostic management conformity to clinical guidelines |
| title | Management of neuroendocrine neoplasms: conformity with guidelines in and outside a center of excellence |
| title_full | Management of neuroendocrine neoplasms: conformity with guidelines in and outside a center of excellence |
| title_fullStr | Management of neuroendocrine neoplasms: conformity with guidelines in and outside a center of excellence |
| title_full_unstemmed | Management of neuroendocrine neoplasms: conformity with guidelines in and outside a center of excellence |
| title_short | Management of neuroendocrine neoplasms: conformity with guidelines in and outside a center of excellence |
| title_sort | management of neuroendocrine neoplasms conformity with guidelines in and outside a center of excellence |
| topic | neuroendocrine neoplasm enets center of excellence diagnostic management conformity to clinical guidelines |
| url | https://ec.bioscientifica.com/view/journals/ec/11/6/EC-22-0097.xml |
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