1
|
Perrier M, Brugel M, Gérard L, Goichot B, Lièvre A, Lepage C, Hautefeuille V, Do Cao C, Smith D, Thuillier P, Cros J, Cadiot G, Walter T, de Mestier L. Characteristics and treatment options of glucagonomas: a national study from the French Group of Endocrine Tumors and ENDOCAN-RENATEN network. Eur J Endocrinol 2023; 189:575-583. [PMID: 38039101 DOI: 10.1093/ejendo/lvad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Glucagonoma is a very rare functional pancreatic neuroendocrine tumor (PanNET). We aimed to provide data on the diagnosis, prognosis, and management of patients with glucagonoma. DESIGN AND METHODS In this retrospective national cohort, we included all patients with glucagonoma, defined by at least 1 major criterion (necrolytic migratory erythema [NME] and/or recent-onset diabetes, and/or weight loss ≥ 5 kg) associated with either glucagonemia > 2 × upper limit of normal or positive glucagon immunostaining. Antisecretory efficacy was defined as partial/complete resolution of glucagonoma symptoms. Antitumor efficacy was assessed according to the time to next treatment (TTNT). RESULTS Thirty-eight patients were included with median age 58.7 yo, primary PanNET located in the tail (68.4%), synchronous metastases (63.2%). Median Ki-67 index was 3%. Most frequent glucagonoma symptoms at diagnosis were NME (86.8%), weight loss (68.4%), and diabetes (50%). Surgery of the primary PanNET was performed in 76.3% of cases, mainly with curative intent (61.5%). After surgery, complete resolution of NME was seen in 93.8% (n = 15/16). The secretory response rates were 85.7%, 85.7%, 75%, and 60% with surgery of metastases (n = 6/7), chemotherapy (n = 6/7), liver-directed therapy (n = 6/8), and somatostatin analogs (n = 6/10), respectively. All lines combined, longer TTNT was reported with chemotherapy (20.2 months). Median overall survival (OS) was 17.3 years. The Ki-67 index > 3% was associated with shorter OS (hazard ratio 5.27, 95% CI [1.11-24.96], P = .036). CONCLUSION Patients with glucagonoma had prolonged survival, even in the presence of metastases at diagnosis. Curative-intent surgery should always be considered. Chemotherapy, peptide receptor radionuclide therapy, or liver-directed therapy seems to provide both substantial antitumor and antisecretory efficacies.
Collapse
Affiliation(s)
- Marine Perrier
- Reims-Champagne-Ardenne University, Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré Hospital, Reims 51100, France
| | - Mathias Brugel
- Reims-Champagne-Ardenne University, Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré Hospital, Reims 51100, France
| | - Laura Gérard
- Department of Digestive Oncology, ENETS Centre of Excellence, Hospices Civils de Lyon, Lyon 69003, France
| | - Bernard Goichot
- Department of Endocrinology, Diabetology & Nutrition, Hôpital Hautepierre, Strasbourg University Hospital, Strasbourg 67200, France
| | - Astrid Lièvre
- Department of Gastroenterology, Pontchaillou University Hospital, Rennes University, INSERM U1242, Rennes 35000, France
| | - Come Lepage
- Federation Francophone de Cancérologie Digestive (FFCD), EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon 21000, France
| | - Vincent Hautefeuille
- Department of Hepato-Gastroenterology and Digestive Oncology, Amiens University Hospital, Amiens 80480, France
| | - Christine Do Cao
- Department of Endocrinology, Hôpital Claude Huriez, Lille University Hospital, Lille 59000, France
| | - Denis Smith
- Department of Hepato-Gastroenterology and Digestive Oncology, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac 33600, France
| | - Philippe Thuillier
- Department of Endocrinology, University Hospital of Brest, Brest 29200, France
| | - Jérôme Cros
- Université Paris-Cité, Department of Pathology, ENETS Centre of Excellence, Beaujon Hospital (APHP.Nord), Clichy 92110, France
| | - Guillaume Cadiot
- Reims-Champagne-Ardenne University, Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré Hospital, Reims 51100, France
| | - Thomas Walter
- Department of Digestive Oncology, ENETS Centre of Excellence, Hospices Civils de Lyon, Lyon 69003, France
| | - Louis de Mestier
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP.Nord), Clichy 92110, France
| |
Collapse
|