Ki-67 index, tumor differentiation, and extent of liver involvement are independent prognostic factors in patients with liver metastases of digestive endocrine carcinomas

被引:57
作者
Hentic, O. [1 ]
Couvelard, A. [2 ]
Rebours, V. [1 ]
Zappa, M. [3 ]
Dokmak, S. [4 ]
Hammel, P. [1 ]
Maire, F. [1 ]
O'Toole, D. [1 ]
Levy, P. [1 ]
Sauvanet, A. [4 ]
Ruszniewski, P. [1 ]
机构
[1] Hop Beaujon, Serv Gastroenterol Pancreatol, Pole Malad Appareil Digest, F-92110 Clichy, France
[2] Hop Beaujon, Serv Pathol, F-92110 Clichy, France
[3] Hop Beaujon, Serv Radiol, F-92110 Clichy, France
[4] Hop Beaujon, Serv Chirurg Digest, Pole Malad Appareil Digest, F-92110 Clichy, France
关键词
HEPATIC ARTERIAL CHEMOEMBOLIZATION; NEUROENDOCRINE TUMORS; CONSENSUS GUIDELINES; NATURAL-HISTORY; CLASSIFICATION; MANAGEMENT; SURVIVAL; PROPOSAL; ETOPOSIDE; RESECTION;
D O I
10.1677/ERC-09-0319
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The prognosis remains ill-defined in patients with liver metastases of well-differentiated (WD) digestive endocrine carcinomas (DEC) with high Ki-67 index. The objectives of this study were to determine whether Ki-67 index, tumor differentiation, and extent of liver involvement are independent prognostic factors in patients with DEC, and whether chemotherapy commonly used in patients with poorly differentiated (PD) carcinomas might be applied to those with high Ki-67 index but well-differentiated DEC. Sixty-three patients with DEC metastatic to the liver were retrospectively studied and divided into three prognostic groups. Group 1 comprised patients with well-differentiated carcinomas and Ki-67 index <15% (n=28), group 2 comprised those with well-differentiated carcinomas and Ki-67 index >= 15% (n=17), and group 3 comprised those with poorly differentiated carcinomas (n=18). Therapeutic strategy was decided in accordance to guidelines, and tumoral response rate was assessed by computed tomography scan (RECIST). Prognostic factors were determined by uni/multivariate analysis. The 5-year survival rates were 89, 36, and 6% in groups 1, 2, and 3 respectively (P<0.001). Multivariate analysis showed that Ki-67 index >= 15%, poor tumor differentiation, and large liver tumor burden were independent predictors of poorer survival. Disease control rates after etoposide-cisplatin were 50 and 53% in groups 2 and 3 respectively (NS). In conclusion, Ki-67 index, tumor differentiation, and extent of liver involvement are independent prognostic factors in patients with liver metastases of DEC. Patients with well-differentiated carcinomas with high Ki-67 index (>= 15%) have intermediate prognosis and a similar response rate to the etoposide-cisplatin combination as those with poorly differentiated carcinomas.
引用
收藏
页码:51 / 59
页数:9
相关论文
共 42 条
  • [1] [Anonymous], INT HISTOLOGICAL CLA
  • [2] Prognostic factors at diagnosis and value of WHO classification in a mono-institutional series of 180 non-functioning pancreatic endocrine tumours
    Bettini, R.
    Boninsegna, L.
    Mantovani, W.
    Capelli, P.
    Bassi, C.
    Pederzoli, P.
    Delle Fave, G. F.
    Panzuto, F.
    Scarpa, A.
    Falconi, M.
    [J]. ANNALS OF ONCOLOGY, 2008, 19 (05) : 903 - 908
  • [3] Prognostic score predicting survival after resection of pancreatic neuroendocrine tumors - Analysis of 3851 patients
    Bilimoria, Karl Y.
    Talamonti, Mark S.
    Tomlinson, James S.
    Stewart, Andrew K.
    Winchester, David P.
    Ko, Clifford Y.
    Bentrem, David J.
    [J]. ANNALS OF SURGERY, 2008, 247 (03) : 490 - 500
  • [4] Hepatic neuroendocrine metastases: Does intervention alter outcomes?
    Chamberlain, RS
    Canes, D
    Brown, KT
    Saltz, L
    Jarnagin, W
    Fong, YM
    Blumgart, LH
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2000, 190 (04) : 432 - 445
  • [5] Proliferative activity in pancreatic endocrine tumors: Association with function, metastases, and survival
    Clarke, MR
    Baker, EE
    Weyant, RJ
    Hill, L
    Carty, SE
    [J]. ENDOCRINE PATHOLOGY, 1997, 8 (03) : 181 - 187
  • [6] Identification of potential therapeutic targets by gene-expression profiling in pancreatic endocrine tumors
    Couvelard, Anne
    Hu, Jiangting
    Steers, Graham
    O'Toole, Dermot
    Sauvanet, Alain
    Belghiti, Jacques
    Bedossa, Pierre
    Gatter, Kevin
    Ruszniewski, Philippe
    Pezzella, Francesco
    [J]. GASTROENTEROLOGY, 2006, 131 (05) : 1597 - 1610
  • [7] Heterogeneity of tumor prognostic markers: a reproducibility study applied to liver metastases of pancreatic endocrine tumors
    Couvelard, Anne
    Deschamps, Lydia
    Ravaud, Philippe
    Baron, Gabriel
    Sauvanet, Alain
    Hentic, Olivia
    Colnot, Nathalie
    Paradis, Valerie
    Belghiti, Jacques
    Bedossa, Pierre
    Ruszniewski, Philippe
    [J]. MODERN PATHOLOGY, 2009, 22 (02) : 273 - 281
  • [8] Dominguez S, 1999, ITAL J GASTROENTEROL, V31, pS213
  • [9] Hepatic arterial chemoembolization with streptozotocin in patients with metastatic digestive endocrine tumours
    Dominguez, S
    Denys, A
    Madeira, I
    Hammel, P
    Vilgrain, V
    Menu, Y
    Bernades, P
    Ruszniewski, P
    [J]. EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, 2000, 12 (02) : 151 - 157
  • [10] A phase II study of irinotecan with 5-fluorouracil and leucovorin in patients with pretreated gastroenteropancreatic well-differentiated endocrine carcinomas
    Ducreux, M. P.
    Boige, V.
    Leboulleux, S.
    Malka, D.
    Kergoat, P.
    Dromain, C.
    Elias, D.
    de Baere, T.
    Sabourin, J. C.
    Duvillard, P.
    [J]. ONCOLOGY, 2006, 70 (02) : 134 - 140