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Hernando J, Roca-Herrera M, García-Álvarez A, Raymond E, Ruszniewski P, Kulke MH, Grande E, Carbonero RG, Castellano D, Salazar R, Ibrahim T, Teule A, Alonso V, Fazio N, Valle JW, Tafuto S, Carmona A, Navarro V, Capdevila J. Corrigendum to "Sex differences on multikinase inhibitors toxicity in patients with advanced gastroenteropancreatic neuroendocrine tumours" [Eur J Cancer 188 (2023) 39-48]. Eur J Cancer 2024:114061. [PMID: 38609739 DOI: 10.1016/j.ejca.2024.114061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Jorge Hernando
- Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
| | - Maria Roca-Herrera
- Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Alejandro García-Álvarez
- Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Eric Raymond
- Department of Oncology, Paris Saint-Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France
| | - Philippe Ruszniewski
- Université Paris Cité, and Dept of Pancreatology-Digestive Oncology, Beaujon Hospital, Clichy, France
| | | | - Enrique Grande
- Medical Oncology Department, MD Anderson Cancer Center Madrid, Madrid, Spain
| | - Rocío García Carbonero
- Oncology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Universidad Complutense de Madrid (UCM), CNIO, CIBERONC, Madrid, Spain
| | - Daniel Castellano
- Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ramón Salazar
- Medical Oncology Department - Institut Català d'Oncologia, Oncobell Program-IDIBELL, University of Barcelona, CIBERONC, Barcelona, Spain
| | - Toni Ibrahim
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies Unit, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alex Teule
- Department of Medical Oncology, Hereditary Cancer Program, Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Catalan Institute of Oncology, l'Hospitalet del Llobregat, Spain
| | - Vicente Alonso
- Oncology Department, Hospital Universitario Miguel Servet, Instituto Investigación Sanitaria Aragón, CIBERONC, Zaragoza, Spain
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | - Juan W Valle
- Division of Cancer Sciences, University of Manchester & Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Salvatore Tafuto
- Sarcoma and Rare Tumors Unit, Istituto Nazionale Tumori I.R.C.C.S., Fondazione "G.Pascale", Naples, Italy
| | - Ana Carmona
- Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Victor Navarro
- Oncology Data Science Group (ODysSey), Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jaume Capdevila
- Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
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Codjia T, Marique L, Aussilhou B, Ftériche FS, de Mestier L, Rebours V, Cros J, Ruszniewski P, Lévy P, Lesurtel M, Sauvanet A, Dokmak S. Outcome and survival were similar with laparoscopic and open pancreatectomy in 102 solid pseudopapillary neoplasms. Surg Endosc 2024; 38:2169-2179. [PMID: 38448620 DOI: 10.1007/s00464-024-10708-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/21/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Solid pseudopapillary neoplasms of the pancreas (SPNP) are rare tumors predominantly in young women. We report the largest single-center cohort study comparing resection of SPNP by laparoscopic approach (LA) and the open approach (OA). METHOD Between 2001 and 2021, 102 patients (84% women, median age: 30) underwent pancreatectomy for SPNP and were retrospectively studied. Demographic, perioperative, pathological, early and the long-term results were evaluated between patients operated by LA and those by OA. RESULTS Population included 40 LA and 62 OA. There were no significant differences in demographics data between the groups. A preoperative biopsy by endoscopic ultrasound was performed in 45 patients (44%) with no difference between the groups. Pancreatoduodenectomy (PD) was less frequently performed by LA (25 vs 53%, p = 0.004) and distal pancreatectomy (DP) was more frequently performed by LA (40 vs 16%, p = 0.003). In the subgroup analysis by surgical procedure, LA-PD was associated with one mortality, less median blood loss (180 vs 200 ml, p = 0.034) and fewer harvested lymph nodes (11 vs 15, p = 0.02). LA-DP was associated with smaller median tumor size on imaging (40 vs 80mm, p = 0.048), shorter surgery (135 vs 190 min, p = 0.028), and fewer complications according to the median comprehensive complication index score (0 vs 8.7, p = 0.048). LA-Central pancreatectomy was associated with shorter surgery (160 vs 240, p = 0.037), less median blood loss (60 vs 200, p = 0.043), and less harvested lymph nodes (5 vs 2, p = 0.025). After a median follow-up of 60 months, two recurrences (2%) were observed and were unrelated to the approach. CONCLUSIONS The LA for SPNP appears to be safe, should be applied cautiously in case of PD for large lesion, and was not associated with recurrence.
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Affiliation(s)
- Tatiana Codjia
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Lancelot Marique
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Béatrice Aussilhou
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Fadhel Samir Ftériche
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Louis de Mestier
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Vinciane Rebours
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Jérome Cros
- AP-HP, Hôpital Beaujon, Department of Pathology, University Paris Cité, Clichy, France
| | - Philippe Ruszniewski
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Philippe Lévy
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Mickael Lesurtel
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Alain Sauvanet
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Safi Dokmak
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France.
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Dufayet L, Piot MA, Geoffroy PA, Oulès B, Petitjean-Brichant C, Peiffer-Smadja N, Bouzid D, Tran Dinh A, Mirault T, Faye A, Lemogne C, Ruszniewski P, Peyre H, Vodovar D. CARECOS study: Medical students' empathy as assessed with the CARE measure by examiners versus standardized patients during a formative Objective and Structured Clinical Examination (OSCE) station. Med Teach 2024:1-9. [PMID: 38285021 DOI: 10.1080/0142159x.2024.2306840] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE To assess the Consultation And Relational Empathy (CARE) measure as a tool for examiners to assess medical students' empathy during Objective and Structured Clinical Examinations (OSCEs), as the best tool for assessing empathy during OSCEs remains unknown. METHODS We first assessed the psychometric properties of the CARE measure, completed simultaneously by examiners and standardized patients (SP, either teachers - SPteacher - or civil society members - SPcivil society), for each student, at the end of an OSCE station. We then assessed the qualitative/quantitative agreement between examiners and SP. RESULTS We included 129 students, distributed in eight groups, four groups for each SP type. The CARE measure showed satisfactory psychometric properties in the context of the study but moderate, and even poor inter-rater reliability for some items. Considering paired observations, examiners scored lower than SPs (p < 0.001) regardless of the SP type. However, the difference in score was greater when the SP was a SPteacher rather than a SPcivil society (p < 0.01). CONCLUSION Despite acceptable psychometric properties, inter-rater reliability of the CARE measure between examiners and SP was unsatisfactory. The choice of examiner as well as the type of SP seems critical to ensure a fair measure of empathy during OSCEs.
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Affiliation(s)
- Laurene Dufayet
- UFR de médecine, Université Paris Cité, Paris, France
- Unité Médico-judiciaire, Hôtel-Dieu, AP-HP, Paris, France
- Centre Antipoison de Paris, Hôpital Fernand-Widal, AP-HP, Paris, France
- INSERM, UMRS-1144, Faculté de pharmacie, Paris, France
| | - Marie-Aude Piot
- UFR de médecine, Université Paris Cité, Paris, France
- Département de psychiatrie de l'enfant et de l'adolescent, Hôpital Necker, AP-HP, Paris, France
- INSERM, UMR 1018, Université Paris-Saclay, Villejuif cedex, France
| | - Pierre-Alexis Geoffroy
- UFR de médecine, Université Paris Cité, Paris, France
- Département de psychiatrie et d'addictologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
- Psychiatrie & Neurosciences, Hôpital Saint-Anne, GHU Paris, Paris, France
- Université de Paris, NeuroDiderot, Inserm, FHU I2-D2, Paris, France
| | - Bénédicte Oulès
- UFR de médecine, Université Paris Cité, Paris, France
- Service de dermatologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Clara Petitjean-Brichant
- Département de psychiatrie et d'addictologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Nathan Peiffer-Smadja
- UFR de médecine, Université Paris Cité, Paris, France
- Service de maladies infectieuses et tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
- Université Paris Cité, INSERM UMR1137, IAME, Paris, France
| | - Donia Bouzid
- UFR de médecine, Université Paris Cité, Paris, France
- Université Paris Cité, INSERM UMR1137, IAME, Paris, France
- Service d'accueil des urgences, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Alexy Tran Dinh
- UFR de médecine, Université Paris Cité, Paris, France
- Département d'anesthésie-réanimation, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Tristan Mirault
- UFR de médecine, Université Paris Cité, Paris, France
- Service de médecine vasculaire, Hôpital Européen Georges Pompidou, Paris, France
| | - Albert Faye
- UFR de médecine, Université Paris Cité, Paris, France
- Service de Pédiatrie générale, Maladies infectieuses et Médecine interne, Hôpital Robert Debré, AP-HP, Paris, France
| | - Cédric Lemogne
- UFR de médecine, Université Paris Cité, Paris, France
- Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France
- Center for Research in Epidemiology and StatisticS (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Paris, France
| | - Philippe Ruszniewski
- UFR de médecine, Université Paris Cité, Paris, France
- Service de gastro-entérologie et pancréatologie, Hôpital Beaujon AP-HP, Clichy, France
| | - Hugo Peyre
- UFR de médecine, Université Paris Cité, Paris, France
- Service de psychiatrie de l'enfant et de l'adolescent, Hôpital Robert Debré, APHP, Paris, France
- INSERM UMR 1141, Université Paris Cité, Paris, France
| | - Dominique Vodovar
- UFR de médecine, Université Paris Cité, Paris, France
- Centre Antipoison de Paris, Hôpital Fernand-Widal, AP-HP, Paris, France
- INSERM, UMRS-1144, Faculté de pharmacie, Paris, France
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Suc G, Cachier A, Hentic O, Bazire B, Sannier A, Delhomme C, Nataf P, Laschet J, Deschamps L, Garbarz E, Ou P, Caligiuri G, Iung B, Ruszniewski P, de Mestier L, Arangalage D. Management and outcomes of carcinoid heart disease with liver metastases of midgut neuroendocrine tumours. Heart 2023; 110:132-139. [PMID: 37463732 DOI: 10.1136/heartjnl-2023-322945] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Despite recent advances in surgical and interventional techniques, knowledge on the management of carcinoid heart disease (CHD) remains limited. In a cohort of patients with liver metastases of midgut neuroendocrine tumours (NETs), we aimed to describe the perioperative management and short-term outcomes of CHD. METHODS From January 2003 to June 2022, consecutive patients with liver metastases of midgut NETs and severe CHD (severe valve disease with symptoms and/or right ventricular enlargement) were included at Beaujon and Bichat hospitals. All patients underwent clinical evaluation and echocardiography. RESULTS Out of 43 (16%) consecutive patients with severe CHD and liver metastases of midgut NETs, 79% presented with right-sided heart failure. Tricuspid valve replacement was performed in 26 (53%) patients including 19 (73%) cases of combined pulmonary valve replacement. The 30-day postoperative mortality rate was high (19%), and preoperative heart failure was associated with worse survival (p=0.02). Epicardial pacemakers were systematically implanted in operated patients and 25% were permanently paced. A postoperative positive right ventricular remodelling was observed (p<0.001). A greater myofibroblastic infiltration was observed in pulmonary versus tricuspid valves (p<0.001), suggesting that they may have been explanted at an earlier stage of the disease than the tricuspid valve, with therefore potential for evolution. CONCLUSIONS We observed a high postoperative mortality rate and baseline right-sided heart failure was associated with worse outcome. In surviving patients, a positive right ventricular remodelling was observed. Prospective, multicentre studies are warranted to better define the management strategy and to identify biomarkers associated with outcome in CHD.
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Affiliation(s)
- Gaspard Suc
- Université Paris Cité, Paris, France
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
| | - Agnès Cachier
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
| | - Olivia Hentic
- Pancreatology, Beaujon Hospital, AP-HP, Paris, France
| | - Baptiste Bazire
- Université Paris Cité, Paris, France
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
| | - Aurélie Sannier
- Université Paris Cité, Paris, France
- UMRS 1148, INSERM, Paris, France
- Pathology, Bichat Hospital, AP-HP, Paris, France
| | - Clémence Delhomme
- Université Paris Cité, Paris, France
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
| | - Patrick Nataf
- Université Paris Cité, Paris, France
- UMRS 1148, INSERM, Paris, France
- Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
| | - Jamila Laschet
- Université Paris Cité, Paris, France
- UMRS 1148, INSERM, Paris, France
| | | | - Eric Garbarz
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
| | - Phalla Ou
- Université Paris Cité, Paris, France
- UMRS 1148, INSERM, Paris, France
- Radiology, Bichat Hospital, AP-HP, Paris, France
| | - Giuseppina Caligiuri
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
| | - Bernard Iung
- Université Paris Cité, Paris, France
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
| | - Philippe Ruszniewski
- Université Paris Cité, Paris, France
- Pancreatology, Beaujon Hospital, AP-HP, Paris, France
| | - Louis de Mestier
- Université Paris Cité, Paris, France
- Pancreatology, Beaujon Hospital, AP-HP, Paris, France
| | - Dimitri Arangalage
- Université Paris Cité, Paris, France
- Cardiology, Bichat and Beaujon Hospitals, APHP, Paris, France
- UMRS 1148, INSERM, Paris, France
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De Rycke O, Perrier M, Ouvrard É, Mennetrey C, Lachachi C, Bando-Delaunay A, Morland D, Goichot B, Taieb D, Walter T, Cadiot G, Cros J, Hentic O, Ruszniewski P, Lebtahi R, Imperiale A, de Mestier L. High Tumor Uptake on 18F-FDOPA PET/CT Indicates Poor Prognosis in Patients with Metastatic Midgut Neuroendocrine Tumors: A Study from the Groupe d'étude des Tumeurs Endocrines and ENDOCAN-RENATEN Network. J Nucl Med 2023; 64:1699-1705. [PMID: 37652547 DOI: 10.2967/jnumed.123.265584] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
PET/CT with 6-18F-fluoro-l-dopa (18F-FDOPA) has high diagnostic performance for midgut neuroendocrine tumors (NETs). We explored the prognostic role of 18F-FDOPA PET/CT uptake in metastatic midgut NETs. Methods: We included, in a test cohort (n = 166) and a full external validation cohort (n = 86), all consecutive patients with metastatic midgut NETs who underwent 18F-FDOPA PET/CT in 5 expert centers from 2010 to 2021. We measured the maximal uptake (SUVmax and SUVpeak) of the tumor and nontumor liver on each 18F-FDOPA PET/CT scan. We measured overall survival (OS) from the time of PET/CT and assessed prognostic factors using Kaplan-Meier and multivariable Cox proportional-hazards analyses in the test cohort, with replication in the validation cohort. Results: Patients had similar characteristics in both cohorts. In the test cohort, median follow-up was 60.3 mo. Patients with an SUVpeak tumor-to-liver (T/L) ratio of more than 4.2 had significantly shorter survival than those with a ratio of 4.2 or less (P = 0.01), with a 5-y OS rate of 74.1% ± 4.5% versus 95% ± 3.4%, respectively. On multivariable analysis, an SUVpeak T/L ratio of more than 4.2 remained associated with shorter OS (hazard ratio, 2.30; 95% CI, 1.02-5.22; P = 0.046) after adjustment for age, grade, number of previous lines, number of metastatic sites, and presence of carcinoid syndrome. In the validation cohort, the 5-y OS rate was 100% versus 57.8% ± 12.5% in patients with an SUVpeak T/L ratio ≤ 4.2 or > 4.2, respectively (P = 0.075). An increasing SUVpeak T/L ratio over time tended to have a pejorative prognostic impact. Conclusion: Tumor uptake on 18F-FDOPA PET/CT is an independent prognostic factor in patients with metastatic midgut NETs.
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Affiliation(s)
- Ophélie De Rycke
- Department of Pancreatology and Digestive Oncology, Beaujon Hospital, Université Paris-Cité, AP-HP.Nord, Clichy, France
- INSERM UMR 1149, Centre de Recherche sur l'Inflammation, Paris, France
| | - Marine Perrier
- Department of Hepato-Gastroenterology and Digestive Oncology, CHU Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Éric Ouvrard
- Department of Nuclear Medicine, Hautepierre University Hospital, Strasbourg, France
| | - Clément Mennetrey
- Department of Nuclear Medicine, La Timone University Hospital, Université d'Aix-Marseille, Marseille, France
| | - Choaib Lachachi
- Department of Nuclear Medicine, Edouard-Herriot University Hospital, Lyon, France
| | - Aurélie Bando-Delaunay
- INSERM UMR 1149, Centre de Recherche sur l'Inflammation, Paris, France
- Department of Nuclear Medicine, Beaujon Hospital, Université Paris-Cité, AP-HP.Nord, Clichy, France
| | - David Morland
- Department of Nuclear Medicine, Institut Godinot, Reims, France
- Université de Reims Champagne Ardenne, CReSTIC, EA 3804, Reims, France
| | - Bernard Goichot
- Department of Endocrinology, Hautepierre University Hospital, Strasbourg, France
| | - David Taieb
- Department of Nuclear Medicine, La Timone University Hospital, Université d'Aix-Marseille, Marseille, France
| | - Thomas Walter
- Department of Digestive Oncology, Edouard-Herriot University Hospital, Lyon, France; and
| | - Guillaume Cadiot
- Department of Hepato-Gastroenterology and Digestive Oncology, CHU Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Jérôme Cros
- INSERM UMR 1149, Centre de Recherche sur l'Inflammation, Paris, France
- Department of Pathology, Beaujon Hospital, AP-HP.Nord, Université Paris-Cité, Clichy, France
| | - Olivia Hentic
- Department of Pancreatology and Digestive Oncology, Beaujon Hospital, Université Paris-Cité, AP-HP.Nord, Clichy, France
| | - Philippe Ruszniewski
- Department of Pancreatology and Digestive Oncology, Beaujon Hospital, Université Paris-Cité, AP-HP.Nord, Clichy, France
- INSERM UMR 1149, Centre de Recherche sur l'Inflammation, Paris, France
| | - Rachida Lebtahi
- INSERM UMR 1149, Centre de Recherche sur l'Inflammation, Paris, France
- Department of Nuclear Medicine, Beaujon Hospital, Université Paris-Cité, AP-HP.Nord, Clichy, France
| | - Alessio Imperiale
- Department of Nuclear Medicine, Hautepierre University Hospital, Strasbourg, France
| | - Louis de Mestier
- Department of Pancreatology and Digestive Oncology, Beaujon Hospital, Université Paris-Cité, AP-HP.Nord, Clichy, France;
- INSERM UMR 1149, Centre de Recherche sur l'Inflammation, Paris, France
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Ronot M, Dioguardi Burgio M, Gregory J, Hentic O, Vullierme MP, Ruszniewski P, Zappa M, de Mestier L. Appropriate use of morphological imaging for assessing treatment response and disease progression of neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab 2023; 37:101827. [PMID: 37858478 DOI: 10.1016/j.beem.2023.101827] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Neuroendocrine tumors (NETs) are relatively rare neoplasms displaying heterogeneous clinical behavior, ranging from indolent to aggressive forms. Patients diagnosed with NETs usually receive a varied array of treatments, including somatostatin analogs, locoregional treatments (ablation, intra-arterial therapy), cytotoxic chemotherapy, peptide receptor radionuclide therapy (PRRT), and targeted therapies. To maximize therapeutic efficacy while limiting toxicity (both physical and economic), there is a need for accurate and reliable tools to monitor disease evolution and progression and to assess the effectiveness of these treatments. Imaging morphological methods, primarily relying on computed tomography (CT) and magnetic resonance imaging (MRI), are indispensable modalities for the initial evaluation and continuous monitoring of patients with NETs, therefore playing a pivotal role in gauging the response to treatment. The primary goal of assessing tumor response is to anticipate and weigh the benefits of treatments, especially in terms of survival gain. The World Health Organization took the pioneering step of introducing assessment criteria based on cross-sectional imaging. This initial proposal standardized the measurement of lesion sizes, laying the groundwork for subsequent criteria. The Response Evaluation Criteria in Solid Tumors (RECIST) subsequently refined and enhanced these standards, swiftly gaining acceptance within the oncology community. New treatments were progressively introduced, targeting specific features of NETs (such as tumor vascularization or expression of specific receptors), and achieving significant qualitative changes within tumors, although associated with minimal or paradoxical effects on tumor size. Several alternative criteria, adapted from those used in other cancer types and focusing on tumor viability, the slow growth of NETs, or refining the existing size-based RECIST criteria, have been proposed in NETs. This review article aims to describe and discuss the optimal utilization of CT and MRI for assessing the response of NETs to treatment; it provides a comprehensive overview of established and emerging criteria for evaluating tumor response, along with comparative analyses. Molecular imaging will not be addressed here and is covered in a dedicated article within this special issue.
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Affiliation(s)
- Maxime Ronot
- Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France; Université Paris-Cité, Department of Radiology, Beaujon Hospital (APHP.Nord), Clichy, France.
| | - Marco Dioguardi Burgio
- Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France; Université Paris-Cité, Department of Radiology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Jules Gregory
- Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France; Université Paris-Cité, Department of Radiology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Olivia Hentic
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | | | - Philippe Ruszniewski
- Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France; Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Magaly Zappa
- Department of Radiology, Cayenne University Hospital, Cayenne, Guyanne, France
| | - Louis de Mestier
- Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France; Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
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Hofland J, Falconi M, Christ E, Castaño JP, Faggiano A, Lamarca A, Perren A, Petrucci S, Prasad V, Ruszniewski P, Thirlwell C, Vullierme MP, Welin S, Bartsch DK. European Neuroendocrine Tumor Society 2023 guidance paper for functioning pancreatic neuroendocrine tumour syndromes. J Neuroendocrinol 2023; 35:e13318. [PMID: 37578384 DOI: 10.1111/jne.13318] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/09/2023] [Accepted: 06/13/2023] [Indexed: 08/15/2023]
Abstract
This ENETS guidance paper aims to provide practical advice to clinicians for the diagnosis, treatment and follow-up of functioning syndromes in pancreatic neuroendocrine tumours (NET). A NET-associated functioning syndrome is defined by the presence of a clinical syndrome combined with biochemical evidence of inappropriately elevated hormonal levels. Different hormonal syndromes can be encountered in pancreatic NET patients, including insulinoma, gastrinoma as well as the rare glucagonoma, VIPoma, ACTHoma, PTHrPoma, carcinoid syndrome, calcitoninoma, GHRHoma and somatostatinoma. The recommendations provided in this paper focus on the biochemical, genetic and imaging work-up as well as therapeutic management of the individual hormonal syndromes in well-differentiated, grade 1-3, functioning NET with the primary tumour originating in the pancreas, and for specific subtypes also in the duodenum.
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Affiliation(s)
- Johannes Hofland
- Department of Internal Medicine, Section of Endocrinology, ENETS Centre of Excellence, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Massimo Falconi
- Pancreatic Surgery and Transplantation Unit, Pancreas Translational and Clinical Research Centre, ENETS Center of Excellence, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Emanuel Christ
- ENETS Centre of Excellence for Neuroendocrine and Endocrine Tumours, University Hospital Basel, Basel, Switzerland
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Justo P Castaño
- Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Córdoba, Spain
- Hospital Universitario Reina Sofía, Córdoba, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Centre of Excellence, Sapienza University of Rome, Rome, Italy
| | - Angela Lamarca
- Department of Oncology - OncoHealth Institute, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Department of Medical Oncology, The Christie NHS Foundation, Manchester, Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Aurel Perren
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Simona Petrucci
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Medical Genetics and Advanced Cell Diagnostics Unit, Sant Andrea University Hospital, Rome, Italy
| | - Vikas Prasad
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Philippe Ruszniewski
- Department of Pancreatology, FHU MOSAIC, Université Paris Cité - APHP Hôpital Beaujon, Clichy, France
| | | | - Marie-Pierre Vullierme
- Centre Hospitalier Annecy Genevois (CHANGE), Université Paris-Cité, Praticien Hospitalier Imagerie Médicale, Annecy, France
| | - Staffan Welin
- Department of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Phillips-University Marburg and University Hospital Gießen Marburg GmbH, Marburg, Germany
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8
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Hernando J, Roca-Herrera M, García-Álvarez A, Raymond E, Ruszniewski P, Kulke MH, Grande E, García-Carbonero R, Castellano D, Salazar R, Ibrahim T, Teule A, Alonso V, Fazio N, Valle JW, Tafuto S, Carmona A, Navarro V, Capdevila J. Sex differences on multikinase inhibitors toxicity in patients with advanced gastroenteropancreatic neuroendocrine tumours. Eur J Cancer 2023; 188:39-48. [PMID: 37196483 DOI: 10.1016/j.ejca.2023.04.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE There is an increasing interest in the role of sex and gender in cancer patients. The impact of sex differences in oncological systemic therapies is still unknown, and there is a lack of evidence specially in uncommon neoplasms like neuroendocrine tumours (NET). In the present study, we combine the differential toxicities by sex in five published clinical trials with multikinase inhibitors (MKI) in gastroenteropancreatic (GEP) NET. METHODS We performed a pooled univariate analysis of reported toxicity in patients treated in five phase 2 and phase 3 clinical trials with MKI in the GEP NET setting: sunitinib (SU11248, SUN1111), Pazopanib (PAZONET), sorafenib-bevacizumab (GETNE0801) and Lenvatinib (TALENT). Differential toxicities between male and female patients were evaluated considering relationship with study drug and different weights of each trial by random effect adjustment. RESULTS We found nine toxicities which were more frequent in female patients (leukopenia, alopecia, vomiting, headache, bleeding, nausea, dysgeusia, neutrophil count decreased and dry mouth) and two toxicities being more frequent in male patients (Anal Symptoms and Insomnia). Asthenia and diarrhoea were the only severe (Grade 3-4) toxicities more frequent in female patients. CONCLUSIONS Sex-related differences in toxicity with the MKI treatment require targeted information and individualised management of patients with NET. Differential reporting of toxicity should be promoted when clinical trials are published.
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Affiliation(s)
- Jorge Hernando
- Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
| | - Maria Roca-Herrera
- Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Alejandro García-Álvarez
- Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Eric Raymond
- Department of Oncology, Paris Saint-Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France
| | - Philippe Ruszniewski
- Université Paris Cité, and Dept of Pancreatology-Digestive Oncology, Beaujon Hospital, Clichy, France
| | | | - Enrique Grande
- Medical Oncology Department, MD Anderson Cancer Center Madrid, Madrid, Spain
| | - Rocío García-Carbonero
- Oncology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Universidad Complutense de Madrid (UCM), CNIO, CIBERONC, Madrid, Spain
| | - Daniel Castellano
- Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ramón Salazar
- Medical Oncology Department - Institut Català d'Oncologia, Oncobell Program-IDIBELL, University of Barcelona, CIBERONC, Barcelona, Spain
| | - Toni Ibrahim
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies Unit, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alex Teule
- Department of Medical Oncology, Hereditary Cancer Program, Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Catalan Institute of Oncology, l'Hospitalet del Llobregat, Spain
| | - Vicente Alonso
- Oncology Department, Hospital Universitario Miguel Servet, Instituto Investigación Sanitaria Aragón, CIBERONC, Zaragoza, Spain
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | - Juan W Valle
- Division of Cancer Sciences, University of Manchester & Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Salvatore Tafuto
- Sarcoma and Rare Tumors Unit, Istituto Nazionale Tumori I.R.C.C.S., Fondazione "G.Pascale", Naples, Italy
| | - Ana Carmona
- Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Victor Navarro
- Oncology Data Science Group (ODysSey). Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jaume Capdevila
- Gastrointestinal and Endocrine Tumor Unit, Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
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9
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Bourdeleau P, Couvelard A, Ronot M, Lebtahi R, Hentic O, Ruszniewski P, Cros J, de Mestier L. Spatial and temporal heterogeneity of digestive neuroendocrine neoplasms. Ther Adv Med Oncol 2023; 15:17588359231179310. [PMID: 37323185 PMCID: PMC10262621 DOI: 10.1177/17588359231179310] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
Neuroendocrine neoplasms (NENs) are initially monoclonal neoplasms that progressively become polyclonal, with very different genotypic and phenotypic characteristics leading to biological differences, including the Ki-67 proliferation index, morphology, or sensitivity to treatments. Whereas inter-patient heterogeneity has been well described, intra-tumor heterogeneity has been little studied. However, NENs present a high degree of heterogeneity, both spatially within the same location or between different lesions, and through time. This can be explained by the emergence of tumor subclones with different behaviors. These subpopulations can be distinguished by the Ki-67 index, but also by the expression of hormonal markers or by differences in the intensity of uptake on metabolic imaging, such as 68Ga-somatostatin receptor and Fluorine-18 fluorodeoxyglucose positron emission tomography. As these features are directly related to prognosis, it seems mandatory to move toward a standardized, improved selection of the tumor areas to be studied to be as predictive as possible. The temporal evolution of NENs frequently leads to changes in tumor grade over time, with impact on prognosis and therapeutic decision-making. However, there is no recommendation regarding systematic biopsy of NEN recurrence or progression, and which lesion to sample. This review aims to summarize the current state of knowledge, the main hypotheses, and the main implications regarding intra-tumor spatial and temporal heterogeneity in digestive NENs.
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Affiliation(s)
- Pauline Bourdeleau
- Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Université Paris-Cité, Clichy, France
| | - Anne Couvelard
- Department of Pathology, Beaujon/Bichat Hospitals (APHP.Nord), Université Paris-Cité, Clichy/Paris, France
- Centre de Recherche sur l’Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital (APHP.Nord), Université Paris-Cité, Clichy, France, and Centre de Recherche sur l’Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France
| | - Rachida Lebtahi
- Department of Nuclear Medicine, Beaujon Hospital (APHP.Nord), Université Paris-Cité, Clichy, France Centre de Recherche sur l’Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France
| | - Olivia Hentic
- Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Université Paris-Cité, Clichy, France
| | - Philippe Ruszniewski
- Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Université Paris-Cité, Clichy, France
- Centre de Recherche sur l’Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France
| | - Jérôme Cros
- Department of Pathology, Beaujon/Bichat Hospitals (APHP.Nord), Université Paris-Cité, Clichy/Paris, France
- Centre de Recherche sur l’Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France
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10
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de Mestier L, Resche-Rigon M, Dromain C, Lamarca A, La Salvia A, de Baker L, Fehrenbach U, Pusceddu S, Colao A, Borbath I, de Haas R, Rinzivillo M, Zerbi A, Funicelli L, de Herder WW, Selberherr A, Wagner AD, Manoharan P, De Cima A, Lybaert W, Jann H, Prinzi N, Faggiano A, Annet L, Walenkamp A, Panzuto F, Pedicini V, Pitoni MG, Siebenhuener A, Mayerhoefer ME, Ruszniewski P, Vullierme MP. Proposal of early CT morphological criteria for response of liver metastases to systemic treatments in gastroenteropancreatic neuroendocrine tumors: Alternatives to RECIST. J Neuroendocrinol 2023; 35:e13311. [PMID: 37345276 DOI: 10.1111/jne.13311] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 06/23/2023]
Abstract
RECIST 1.1 criteria are commonly used with computed tomography (CT) to evaluate the efficacy of systemic treatments in patients with neuroendocrine tumors (NETs) and liver metastases (LMs), but their relevance is questioned in this setting. We aimed to explore alternative criteria using different numbers of measured LMs and thresholds of size and density variation. We retrospectively studied patients with advanced pancreatic or small intestine NETs with LMs, treated with systemic treatment in the first-and/or second-line, without early progression, in 14 European expert centers. We compared time to treatment failure (TTF) between responders and non-responders according to various criteria defined by 0%, 10%, 20% or 30% decrease in the sum of LM size, and/or by 10%, 15% or 20% decrease in LM density, measured on two, three or five LMs, on baseline (≤1 month before treatment initiation) and first revaluation (≤6 months) contrast-enhanced CT scans. Multivariable Cox proportional hazard models were performed to adjust the association between response criteria and TTF on prognostic factors. We included 129 systemic treatments (long-acting somatostatin analogs 41.9%, chemotherapy 26.4%, targeted therapies 31.8%), administered as first-line (53.5%) or second-line therapies (46.5%) in 91 patients. A decrease ≥10% in the size of three LMs was the response criterion that best predicted prolonged TTF, with significance at multivariable analysis (HR 1.90; 95% CI: 1.06-3.40; p = .03). Conversely, response defined by RECIST 1.1 did not predict prolonged TTF (p = .91), and neither did criteria based on changes in LM density. A ≥10% decrease in size of three LMs could be a more clinically relevant criterion than the current 30% threshold utilized by RECIST 1.1 for the evaluation of treatment efficacy in patients with advanced NETs. Its implementation in clinical trials is mandatory for prospective validation. Criteria based on changes in LM density were not predictive of treatment efficacy. CLINICAL TRIAL REGISTRATION: Registered at CNIL-CERB, Assistance publique hopitaux de Paris as "E-NETNET-L-E-CT" July 2018. No number was assigned. Approved by the Medical Ethics Review Board of University Medical Center Groningen.
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Affiliation(s)
- Louis de Mestier
- Department of Pancreatology and Digestive Oncology, Université Paris-Cité, INSERM U1149, Beaujon University Hospital, Clichy, France
| | - Matthieu Resche-Rigon
- Department of Epidemiology and Biostatistics, Université Paris-Cité, Saint-Louis Hospital, Paris, France
| | - Clarisse Dromain
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Angela Lamarca
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | - Anna La Salvia
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lesley de Baker
- Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sara Pusceddu
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Università Federico II di Napoli, Naples, Italy
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, ENETS Center of Excellence, Rome, Italy
| | - Ivan Borbath
- Department of Hepatology and Gastroenterology, University Hospital St Luc/UCLouvain, Woluwe, Belgium
| | - Robbert de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Rinzivillo
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery, Humanitas Clinical and Research Center, Rozzano-, Milano, Italy
| | - Luigi Funicelli
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Wouter W de Herder
- Department of Internal Medicine, Erasmus MC and Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Andreas Selberherr
- Division of General Surgery, Department of Surgery, Medical University, Vienna, Austria
- Department of General and Visceral Surgery, Evangelisches Krankenhaus Wien, Vienna, Austria
| | - Anna Dorothea Wagner
- Department of Medical Oncology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Prakash Manoharan
- Department of Radiology and Nuclear Medicine, The Christie, Manchester, UK
| | - Andrea De Cima
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Willem Lybaert
- Department of Medical Oncology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Henning Jann
- Department of Hepatology and Gastroenterology, Charité-University, Charité-Universitätsmedizin, Berlin, Germany
| | - Natalie Prinzi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Università Federico II di Napoli, Naples, Italy
| | - Laurence Annet
- Department of Radiology, Cliniques Universitaires Saint-Luc/UCLouvain, Brussels, Belgium
| | - Annemiek Walenkamp
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Francesco Panzuto
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy
| | - Vittorio Pedicini
- Department of Radiology, Humanitas Clinical and Research Center, Rozzano-Milano, Italy
| | | | - Alexander Siebenhuener
- Department of Gastroenterology and Hepatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Philippe Ruszniewski
- Department of Pancreatology and Digestive Oncology, Université Paris-Cité, INSERM U1149, Beaujon University Hospital, Clichy, France
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11
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Alexandra JF, Roux D, Maisonneuve H, Chousterman B, Ruszniewski P, Dreyfuss D. Toward improvement of knowledge of financial conflicts of interest in a large medical school in France. PLoS One 2023; 18:e0285894. [PMID: 37216355 DOI: 10.1371/journal.pone.0285894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Conflict of interests (COIs) adversely affect the integrity of science and public health. The role of medical schools in the teaching and management of COIs has been highlighted by the publication of an annual evaluation of American medical schools based on their COIs policies by the American Medical Student Association (AMSA). A deontological charter was adopted by French medical schools in 2018 but its impact on COI comprehension by students and its effects on COI prevention were not evaluated. METHODS A 10-item direct survey was conducted among about 1000 students in Paris-Cité University in order to investigate the respect of the charter regarding COIs both in the medical school and in affiliated teaching hospitals. RESULTS Cumulative results show a satisfying respect of prevention policies regarding COIs in the medical school and hospitals despite the fact that the existence of the charter and its major aspects were insufficiently known. Disclosure of COIs by teachers was insufficient. CONCLUSION This first direct study among students shows better results than expected according to current non-academic surveys. Moreover, this study demonstrates the feasibility of this kind of survey whose repetition should be an appropriate tool to improve the implementation of the charter within medical schools and teaching hospitals, in particular mandatory disclosure of COIs by teachers.
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Affiliation(s)
- J F Alexandra
- APHP, Hôpital Bichat Claude Bernard, Service de Médecine Interne DMU Victoire Paris, Paris, France
- Université Paris-Cité, Paris, France
| | - D Roux
- AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
- Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker Enfants Malades, Paris, France
| | - H Maisonneuve
- Hervé Maisonneuve, MD, Scientific Editor & Consultant, Paris, France
| | - B Chousterman
- Université Paris-Cité, Paris, France
- Hervé Maisonneuve, MD, Scientific Editor & Consultant, Paris, France
| | - P Ruszniewski
- Doyen de l'UFR de Médecine, Université Paris Cité, Pairs, France
| | - D Dreyfuss
- Université Paris-Cité, Paris, France
- AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Common and Rare Kidney Diseases (CORAKID), Hôpital Tenon, Sorbonne Université, Paris, France
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12
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Delhomme C, Walter T, Arangalage D, Suc G, Hentic O, Cachier A, Alkhoder S, François L, Lombard-Bohas C, Iung B, Ruszniewski P, de Mestier L. Carcinoid heart disease in patients with midgut neuroendocrine tumours. J Neuroendocrinol 2023; 35:e13262. [PMID: 37005217 DOI: 10.1111/jne.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/29/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
Carcinoid heart disease (CHD) is the main complication of carcinoid syndrome (CS) associated with metastatic small intestine neuroendocrine tumours (NETs). The pathophysiology of CHD is partly understood but vasoactive hormones secreted by NETs, especially serotonin, play a major role, leading to the formation of fibrous plaques. These plaque-like deposits involve the right side of the heart in >90% of cases, particularly the tricuspid and pulmonary valves, which become thickened, retracted and immobile, resulting in regurgitation or stenosis. CHD represents a major diagnostic and therapeutic challenge for patients with NET and CS and is associated with increased risk of morbidity and mortality. CHD often occurs 2-5 years after the diagnosis of metastatic NET, but diagnosis of CHD can be delayed as patients are often asymptomatic for a long time despite severe heart valve involvement. Circulating biomarkers (5HIAA, NT-proBNP) are relevant tools but transthoracic echocardiography is the key examination for diagnosis and follow-up of CHD. However, there is no consensus on the optimal indications and frequency of TTE and biomarker dosing regarding screening and diagnosis. Treatment of CHD is complex and requires a multidisciplinary approach. It relies on antitumour treatment, control of CS and surgical valve replacement in cases of severe CHD. However, cardiac surgery is associated with a high risk of mortality, notably due to perioperative carcinoid crisis and right ventricular dysfunction. Timing of surgery is the most crucial point of CHD management and relies on the case-by-case determination of the optimal compromise between tumour progression, cardiac symptoms and CS control.
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Affiliation(s)
- Clémence Delhomme
- Université Paris-Cité, Department of Cardiology, Bichat/Beaujon Hospital (APHP.Nord), ENETS Centre of Excellence, Paris/Clichy, France
| | - Thomas Walter
- Hospices Civils de Lyon, Department of Medical Oncology, ENETS Centre of Excellence, Lyon, France
| | - Dimitri Arangalage
- Université Paris-Cité, Department of Cardiology, Bichat/Beaujon Hospital (APHP.Nord), ENETS Centre of Excellence, Paris/Clichy, France
| | - Gaspard Suc
- Université Paris-Cité, Department of Cardiology, Bichat/Beaujon Hospital (APHP.Nord), ENETS Centre of Excellence, Paris/Clichy, France
| | - Olivia Hentic
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Agnès Cachier
- Université Paris-Cité, Department of Cardiology, Bichat/Beaujon Hospital (APHP.Nord), ENETS Centre of Excellence, Paris/Clichy, France
| | - Soleiman Alkhoder
- Université Paris-Cité, Department of Cardiac Surgery, Bichat Hospital (APHP.Nord), ENETS Centre of Excellence, Paris, France
| | - Laurent François
- Hospices Civils de Lyon, Department of Cardiology, ENETS Centre of Excellence, Lyon, France
| | - Catherine Lombard-Bohas
- Hospices Civils de Lyon, Department of Medical Oncology, ENETS Centre of Excellence, Lyon, France
| | - Bernard Iung
- Université Paris-Cité, Department of Cardiology, Bichat/Beaujon Hospital (APHP.Nord), ENETS Centre of Excellence, Paris/Clichy, France
| | - Philippe Ruszniewski
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Louis de Mestier
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP.Nord), Clichy, France
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13
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Tsopra R, Peiffer-Smadja N, Charlier C, Campeotto F, Lemogne C, Ruszniewski P, Vivien B, Burgun A. Putting undergraduate medical students in AI-CDSS designers' shoes: An innovative teaching method to develop digital health critical thinking. Int J Med Inform 2023; 171:104980. [PMID: 36681042 DOI: 10.1016/j.ijmedinf.2022.104980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Digital health programs are urgently needed to accelerate the adoption of Artificial Intelligence and Clinical Decision Support Systems (AI-CDSS) in clinical settings. However, such programs are still lacking for undergraduate medical students, and new approaches are required to prepare them for the arrival of new and unknown technologies. At University Paris Cité medical school, we designed an innovative program to develop the digital health critical thinking of undergraduate medical students that consisted of putting medical students in AI-CDSS designers' shoes. METHODS We followed the six steps of Kern's approach for curriculum development: identification of needs, definition of objectives, design of an educational strategy, implementation, development of an assessment and design of program evaluation. RESULTS A stand-alone and elective AI-CDSS program was implemented for fourth-year medical students. Each session was designed from an AI-CDSS designer viewpoint, with theoretical and practical teaching and brainstorming time on a project that consisted of designing an AI-CDSS in small groups. From 2021 to 2022, 15 students were enrolled: they rated the program 4.4/5, and 80% recommended it. Seventy-four percent considered that they had acquired new skills useful for clinical practice, and 66% felt more confident with technologies. The AI-CDSS program aroused great enthusiasm and strong engagement of students: 8 designed an AI-CDSS and wrote two scientific 5-page articles presented at the Medical Informatics Europe conference; 4 students were involved in a CDSS research project; 2 students asked for a hospital internship in digital health; and 1 decided to pursue PhD training. DISCUSSION Putting students in AI-CDSS designers' shoes seemed to be a fruitful and innovative strategy to develop digital health skills and critical thinking toward AI technologies. We expect that such programs could help future doctors work in rapidly evolving digitalized environments and position themselves as key leaders in digital health.
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Affiliation(s)
- Rosy Tsopra
- Université Paris Cité, UFR de Médecine, Digital Health Program, Paris, France; Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France; Inria, HeKA, PariSanté Campus Paris, France; Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou, F-75015 Paris, France
| | - Nathan Peiffer-Smadja
- Université Paris Cité, UFR de Médecine, Paris, France; Université Paris Cité, INSERM, IAME, F-75018 Paris, France; Infectious Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, F-75018 Paris, France
| | - Caroline Charlier
- Université Paris Cité, UFR de Médecine, Paris, France; Cochin University Hospital, Division of Infectious Diseases and Tropical Medicine, AP-HP, Paris, France; Institut Pasteur, National Reference Center and WHO Collaborating Center Listeria, Paris, France; Institut Pasteur, Inserm U1117, Biology of Infection Unit, Paris, France
| | - Florence Campeotto
- Université Paris Cité, UFR de Médecine, Paris, France; Régulation Régionale Pédiatrique, SAMU de Paris, AP-HP, Hôpital Necker - Enfants Malades, Paris, France; Gastro-entérologie pédiatrique, AP-HP, Hôpital Necker - Enfants Malades, Paris, France; Faculté de Pharmacie, Université Paris Cité, Inserm UMR S1139, Paris, France
| | - Cédric Lemogne
- Université Paris Cité, UFR de Médecine, Paris, France; Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, F-75014 Paris, France; Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, F-75004 Paris, France
| | - Philippe Ruszniewski
- Université Paris Cité, UFR de Médecine, Paris, France; Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France; Service de gastro-entérologie et pancréatologie, Hôpital Beaujon AP-HP, Paris, France
| | - Benoît Vivien
- Université Paris Cité, UFR de Médecine, Paris, France; Régulation Régionale Pédiatrique, SAMU de Paris, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Anita Burgun
- Université Paris Cité, UFR de Médecine, Digital Health Program, Paris, France; Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France; Inria, HeKA, PariSanté Campus Paris, France; Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou, F-75015 Paris, France
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14
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Assouline J, Cannella R, Porrello G, de Mestier L, Dioguardi Burgio M, Raynaud L, Hentic O, Cros J, Tselikas L, Ruszniewski P, Vullierme MP, Vilgrain V, Duran R, Ronot M. Volumetric Enhancing Tumor Burden at CT to Predict Survival Outcomes in Patients with Neuroendocrine Liver Metastases after Intra-arterial Treatment. Radiol Imaging Cancer 2023; 5:e220051. [PMID: 36607243 PMCID: PMC9896229 DOI: 10.1148/rycan.220051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose To investigate whether liver enhancing tumor burden (LETB) assessed at contrast-enhanced CT indicates early response and helps predict survival outcomes in patients with multifocal neuroendocrine liver metastases (NELM) after intra-arterial treatment. Materials and Methods This retrospective study included patients with NELM who underwent intra-arterial treatment with transarterial embolization (TAE) or chemoembolization (TACE) between April 2006 and December 2018. Tumor response in treated NELM was evaluated by using the Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST). LETB was measured as attenuation 2 SDs greater than that of a region of interest in the nontumoral liver parenchyma. Overall survival (OS); time to unTA(C)Eable progression, defined as the time from the initial treatment until the time when intra-arterial treatments were considered technically unfeasible, either not recommended by the multidisciplinary tumor board or until death; and hepatic and whole-body progression-free survival (PFS) were evaluated using multivariable Cox proportional hazards analyses, the Kaplan-Meier method, and log-rank test. Results The study included 119 patients (mean age, 60 years ± 11 [SD]; 61 men) who underwent 161 treatments. A median LETB change of -25.8% best discriminated OS (83 months in responders vs 51 months in nonresponders; P = .02) and whole-body PFS (18 vs 8 months, respectively; P < .001). A -10% LETB change best discriminated time to unTA(C)Eable progression (32 months in responders vs 12 months in nonresponders; P < .001) and hepatic PFS (18 vs 8 months, respectively; P < .001). LETB change remained independently associated with improved OS (hazard ratio [HR], 0.56), time to unTA(C)Eable progression (HR, 0.44), hepatic PFS (HR, 0.42), and whole-body PFS (HR, 0.47) on multivariable analysis. Neither RECIST nor mRECIST helped predict patient outcome. Conclusion Response according to LETB change helped predict survival outcomes in patients with NELM after intra-arterial treatments, with better discrimination than RECIST and mRECIST. Keywords: CT, Chemoembolization, Embolization, Abdomen/GI, Liver Supplemental material is available for this article. © RSNA, 2023.
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15
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Lacombe C, Perrier M, Hentic O, Brixi H, De Rycke O, Cros J, Rebours V, Cadiot G, Ruszniewski P, de Mestier L. FOLFOX-bevacizumab chemotherapy in patients with metastatic neuroendocrine tumors. J Neuroendocrinol 2023; 35:e13227. [PMID: 36599808 PMCID: PMC10078167 DOI: 10.1111/jne.13227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
Neuroendocrine tumors (NETs) are highly vascularized neoplasms. While FOLFOX chemotherapy has shown efficacy in patients with advanced NETs, its combination with antiangiogenics has been scarcely described. Here, we report the efficacy and tolerance of FOLFOX-bevacizumab in this setting. We retrospectively studied all consecutive patients with metastatic NET treated by FOLFOX-bevacizumab in two expert centers from 2013 to 2020. We assessed time to treatment failure (TTF), objective response rate (ORR) and toxicity. We explored factors associated with TTF and ORR using multivariate analyses. We included 57 patients (35.1% female, median age 61.7 years), with pancreatic (66.7%), small-intestine (14%) or lung (7%) NETs. Most patients (57.9%) had extra-hepatic metastases and G3 NETs accounted for 40.3% of cases. Patients received a median of 17 cycles of treatment, including a median of seven cycles of bevacizumab and/or 5-fluorouracile maintenance. Median TTF was 15.5 months (95% CI: 9.8-21.2) and was shorter in patients age > 60 years (HR 2.56, 95% CI: 1.16-5.64), p = .020) and >1 previous systemic treatment line (HR 4.15, 95% CI: 1.96-8.78), p < .001). The ORR was 42.9% and was higher in cases of performance status at 0 (OR 5.25, 95% CI: 1.13-24.35), p = .034) and G3 NET (OR 5.39, 95% CI: 1.23-23.52), p = .025). The FOLFOX-bevacizumab combination has promising efficacy in patients with progressive metastatic NETs and notably for G3 NETs, for which optimal treatment as yet remains ill-defined. Hence, it could be a relevant alternative to alkylating-based chemotherapy in this setting and should be further explored prospectively.
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Affiliation(s)
- Caroline Lacombe
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
- Université Paris-Cité, Center of Research on Inflammation, INSERM U1149, Paris, France
| | - Marine Perrier
- Université de Reims-Champagne-Ardenne, Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré Hospital, Reims, France
| | - Olivia Hentic
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Hedia Brixi
- Université de Reims-Champagne-Ardenne, Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré Hospital, Reims, France
| | - Ophélie De Rycke
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
- Université Paris-Cité, Center of Research on Inflammation, INSERM U1149, Paris, France
| | - Jérôme Cros
- Université Paris-Cité, Center of Research on Inflammation, INSERM U1149, Paris, France
- Université Paris-Cité, Department of Pathology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Vinciane Rebours
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
- Université Paris-Cité, Center of Research on Inflammation, INSERM U1149, Paris, France
| | - Guillaume Cadiot
- Université de Reims-Champagne-Ardenne, Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré Hospital, Reims, France
| | - Philippe Ruszniewski
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
- Université Paris-Cité, Center of Research on Inflammation, INSERM U1149, Paris, France
| | - Louis de Mestier
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
- Université Paris-Cité, Center of Research on Inflammation, INSERM U1149, Paris, France
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16
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Bouzid D, Mullaert J, Ghazali A, Ferré VM, Mentré F, Lemogne C, Ruszniewski P, Faye A, Dinh AT, Mirault T. eOSCE stations live versus remote evaluation and scores variability. BMC Med Educ 2022; 22:861. [PMID: 36514011 PMCID: PMC9745699 DOI: 10.1186/s12909-022-03919-1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Objective structured clinical examinations (OSCEs) are known to be a fair evaluation method. These recent years, the use of online OSCEs (eOSCEs) has spread. This study aimed to compare remote versus live evaluation and assess the factors associated with score variability during eOSCEs. METHODS We conducted large-scale eOSCEs at the medical school of the Université de Paris Cité in June 2021 and recorded all the students' performances, allowing a second evaluation. To assess the agreement in our context of multiple raters and students, we fitted a linear mixed model with student and rater as random effects and the score as an explained variable. RESULTS One hundred seventy observations were analyzed for the first station after quality control. We retained 192 and 110 observations for the statistical analysis of the two other stations. The median score and interquartile range were 60 out of 100 (IQR 50-70), 60 out of 100 (IQR 54-70), and 53 out of 100 (IQR 45-62) for the three stations. The score variance proportions explained by the rater (ICC rater) were 23.0, 16.8, and 32.8%, respectively. Of the 31 raters, 18 (58%) were male. Scores did not differ significantly according to the gender of the rater (p = 0.96, 0.10, and 0.26, respectively). The two evaluations showed no systematic difference in scores (p = 0.92, 0.053, and 0.38, respectively). CONCLUSION Our study suggests that remote evaluation is as reliable as live evaluation for eOSCEs.
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Affiliation(s)
- Donia Bouzid
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm IAME, F-75018, Paris, France.
- Emergency Department, Bichat-Claude Bernard University Hospital AP-HP, Paris, France.
| | - Jimmy Mullaert
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm IAME, F-75018, Paris, France
| | - Aiham Ghazali
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm IAME, F-75018, Paris, France
| | - Valentine Marie Ferré
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm IAME, F-75018, Paris, France
- Virology laboratory, Bichat-Claude Bernard University Hospital AP-HP, Paris, France
| | - France Mentré
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm IAME, F-75018, Paris, France
- Département d'Épidémiologie, Biostatistique et Recherche Clinique, Bichat-Claude Bernard University Hospital AP-HP, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Cédric Lemogne
- UFR de Médecine, Université Paris Cité, Paris, France
- Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neuroscience de Paris, F-75014, Paris, France
- Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, F-75004, Paris, France
| | - Philippe Ruszniewski
- UFR de Médecine, Université Paris Cité, Paris, France
- Service de gastro-entérologie et pancréatologie, Hôpital Beaujon AP-HP, Paris, France
| | - Albert Faye
- UFR de Médecine, Université Paris Cité, Paris, France
- Service de Pédiatrie Générale, Hôpital Robert Debré AP-HP, Paris, France
| | - Alexy Tran Dinh
- UFR de Médecine, Université Paris Cité, Paris, France
- Département d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Tristan Mirault
- UFR de Médecine, Université Paris Cité, Paris, France
- Département de médecine vasculaire, Hôpital Européen Georges Pompidou AP-HP, Paris, France
- Université Paris Cité, PARCC team 5, INSERM U970, F-75015, Paris, France
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17
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Dokmak S, Cauchy F, Aussilhou B, Dondero F, Sepulveda A, Roux O, Francoz C, Hentic O, de Mestier L, Levy P, Ruszniewski P, Ronot M, Cros J, Vilgrain V, Paradis V, Dahmani S, Weiss E, Sauvanet A, Durand F, Lesurtel M. Laparoscopic-assisted liver transplantation: A realistic perspective. Am J Transplant 2022; 22:3069-3077. [PMID: 35704274 DOI: 10.1111/ajt.17118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/04/2022] [Accepted: 06/04/2022] [Indexed: 01/25/2023]
Abstract
Laparoscopic approach was rarely described in recipients for liver transplantation (LT). We report the feasibility and safety of laparoscopic-assisted LT (LA-LT) in patients with unresectable liver metastases of neuroendocrine tumors. Total hepatectomy was performed laparoscopically with graft implantation through an upper midline incision. Liver grafts were retrieved from deceased donors. From July 2019 to July 2021, six patients (4 women, 2 men) underwent LA-LT. Median age and BMI were 46 (29-54) and 24 (19-35) kg/m2 , respectively. Implanted grafts were reduced (n = 3), full (n = 2), and a right split liver (n = 1). Median surgical time was 405 min (390-450) and median blood loss was 425 ml (250-600). Median cold and warm ischemia times were 438 min (360-575) and 35 min (30-40), respectively. Median anhepatic phase was 51 min (40-67) and midline incision was 14 cm (13-20) long. On postoperative day 5, median prothrombin index and serum bilirubin levels were 95% (70-117) and 11 (10-37) μmol/L, respectively. No Clavien-Dindo > III complications were encountered. Median hospital stay was 12 days (10-14). After a median follow-up of 8 (8-32) months, all patients were alive without tumor recurrence or adverse event. This preliminary series suggests that in selected patients, LA-LT is a safe and effective option.
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Affiliation(s)
- Safi Dokmak
- Department of HPB surgery and liver transplantation, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - François Cauchy
- Department of HPB surgery and liver transplantation, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France.,University of Paris Cité, Paris, France
| | - Béatrice Aussilhou
- Department of HPB surgery and liver transplantation, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Fédérica Dondero
- Department of HPB surgery and liver transplantation, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Ailton Sepulveda
- Department of HPB surgery and liver transplantation, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Olivier Roux
- Department of Hepatology, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Claire Francoz
- Department of Hepatology, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Olivia Hentic
- Department of Gastroenterology and Pancreatology, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Louis de Mestier
- University of Paris Cité, Paris, France.,Department of Gastroenterology and Pancreatology, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Philippe Levy
- University of Paris Cité, Paris, France.,Department of Gastroenterology and Pancreatology, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Philippe Ruszniewski
- University of Paris Cité, Paris, France.,Department of Gastroenterology and Pancreatology, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Maxime Ronot
- University of Paris Cité, Paris, France.,Department of Radiology, AP-HP, Beaujon Hospital, Clichy, France
| | - Jérome Cros
- University of Paris Cité, Paris, France.,Department of Pathology, AP-HP, Beaujon Hospital, Clichy, France
| | - Valérie Vilgrain
- University of Paris Cité, Paris, France.,Department of Radiology, AP-HP, Beaujon Hospital, Clichy, France
| | - Valérie Paradis
- University of Paris Cité, Paris, France.,Department of Pathology, AP-HP, Beaujon Hospital, Clichy, France
| | - Souhayl Dahmani
- University of Paris Cité, Paris, France.,Department of Anesthesiology and Reanimation, AP-HP, Beaujon Hospital, Clichy, France
| | - Emmanuel Weiss
- University of Paris Cité, Paris, France.,Department of Anesthesiology and Reanimation, AP-HP, Beaujon Hospital, Clichy, France
| | - Alain Sauvanet
- Department of HPB surgery and liver transplantation, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France.,University of Paris Cité, Paris, France
| | - François Durand
- University of Paris Cité, Paris, France.,Department of Hepatology, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Mickael Lesurtel
- Department of HPB surgery and liver transplantation, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France.,University of Paris Cité, Paris, France
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18
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Bouzid D, Mirault T, Ghazali A, Muller L, Casalino E, Peiffer Smadja N, Auber B, Guerin M, Sambet CH, Etienne I, De Lastours V, Badoual C, Lemogne C, Ruszniewski P, Université Paris Cité’ OSCE study group, Faye A, Tran Dinh A. Feasibility of large-scale eOSCES: the simultaneous evaluation of 500 medical students during a mock examination. Med Educ Online 2022; 27:2084261. [PMID: 35698458 PMCID: PMC9225734 DOI: 10.1080/10872981.2022.2084261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/13/2022] [Accepted: 05/25/2022] [Indexed: 09/23/2023]
Abstract
UNLABELLED The COVID-19 pandemic has led health schools to cancel many on-site training and exams. Teachers were looking for the best option to carry out online OSCEs, and Zoom was the obvious choice since many schools have used it to pursue education purposes. METHODS We conducted a feasibility study during the 2020-2021 college year divided into six pilot phases and the large-scale eOSCEs on Zoom on June 30th, 2021. We developed a specific application allowing us to mass create Zoom meetings and built an entire organization, including a technical support system (an SOS room and catching-up rooms) and teachers' training sessions. We assessed satisfaction via an online survey. RESULTS On June 30th, 531/794 fifth-year medical students (67%) participated in a large-scale mock exam distributed in 135 Zoom meeting rooms with the mobilization of 298 teachers who either participated in the Zoom meetings as standardized patients (N =135, 45%) or examiners (N =135, 45%) or as supervisors in the catching-up rooms (N =16, 6%) or the SOS room (N =12, 4%). In addition, 32/270 teachers (12%) experienced difficulties connecting to their Zoom meetings and sought the help of an SOS room member. Furthermore, 40/531 students (7%) were either late to their station or had technical difficulties and declared those issues online and were welcomed in one of the catching-up rooms to perform their eOSCE stations. Additionally, 518/531 students (98%) completed the entire circuit of three stations, and 225/531 students (42%) answered the online survey. Among them, 194/225 (86%) found eOSCES helpful for training and expressed their satisfaction with this experience. CONCLUSION Organizing large-scale eOSCEs on Zoom is feasible with the appropriate tools. In addition, eOCSEs should be considered complementary to on-site OSCEs and to train medical students in telemedicine.
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Affiliation(s)
- Donia Bouzid
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm IAME, F-75018Paris, France
- Emergency Department, Bichat-Claude Bernard University Hospital AP-HP, Paris, France
| | - Tristan Mirault
- UFR de Médecine, Université Paris Cité, Paris, France
- Département d’hypertension artérielle, Hôpital Européen Georges PompidouAP-HP, Paris, France
| | - Aiham Ghazali
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm IAME, F-75018Paris, France
| | | | - Enrique Casalino
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm IAME, F-75018Paris, France
- Emergency Department, Bichat-Claude Bernard University Hospital AP-HP, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Nathan Peiffer Smadja
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm IAME, F-75018Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
- Infectious diseases Unit, Bichat-Claude Bernard University Hospital AP-HP, Paris, France
| | - Baptiste Auber
- Account executive- Higher Education- Zoom, San José, California
| | | | | | | | - Victoire De Lastours
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm IAME, F-75018Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
- Service de Médecine Interne, Hôpital Beaujon AP-HP, Clichy, France
| | - Cécile Badoual
- UFR de Médecine, Université Paris Cité, Paris, France
- Service d’anatomopathologie, Hôpital Européen Georges Pompidou AP-HP, Paris, France
| | - Cédric Lemogne
- UFR de Médecine, Université Paris Cité, Paris, France
- Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neuroscience de Paris, F-75014 Paris, France
- Service de Psychiatrie de l’adulte, AP-HP, Hôpital Hôtel-Dieu, F-75004 Paris, France
| | - Philippe Ruszniewski
- UFR de Médecine, Université Paris Cité, Paris, France
- Service de gastro-entérologie et pancréatologie, Hôpital Beaujon AP-HP, Paris, France
| | | | - Albert Faye
- UFR de Médecine, Université Paris Cité, Paris, France
- Service de Pédiatrie Générale, Hôpital Robert Debré AP-HP, Paris, France
| | - Alexy Tran Dinh
- UFR de Médecine, Université Paris Cité, Paris, France
- Département d’Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
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19
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de Mestier L, Nicolle R, Poté N, Rebours V, Cauchy F, Hentic O, Maire F, Ronot M, Lebtahi R, Sauvanet A, Paradis V, Ruszniewski P, Couvelard A, Cros J. Molecular deciphering of primary liver neuroendocrine neoplasms confirms its distinct existence with foregut-like profile. J Pathol 2022; 258:58-68. [PMID: 35681273 DOI: 10.1002/path.5977] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/06/2022] [Accepted: 06/06/2022] [Indexed: 11/08/2022]
Abstract
Isolated hepatic localizations of neuroendocrine tumors (NETs) are generally considered as metastatic NETs of unknown primary but could correspond to primary hepatic NETs (PHNETs), a poorly explored entity. We aimed to describe the clinicopathological and molecular features of PHNETs and compare them with other primary NETs. We assembled a retrospective cohort of patients managed for hepatic localization of NET without extra-hepatic primary tumor after exhaustive clinical, imaging and immunohistochemical characterization. We performed whole-exome sequencing with mutational and copy number analysis. Transcriptomic profiles were compared to pancreatic (n=31), small-bowel (n=22) and lung (n=15) NETs using principal component analysis, unsupervised clustering and gene-set enrichment analysis. Among 27 screened patients, 16 had PHNET (solitary tumor in 63%, median size 11 cm, G2 NETs in 81%) following clinical and pathological review. DNA analyses showed "foregut-like" genomic profiles with frequent alterations in pathways of Fanconi DNA repair (75%), histone modifiers (58%), adherens junctions (58%) and cell cycle control (50%). The most frequently involved genes were KMT2A (58%), ATM (42%), CDH1, CDKN2C, FANCF and MEN1 (33% each). Transcriptomic analyses showed that PHNETs clustered closer to foregut (pancreatic, lung) NETs than to midgut (small-bowel) NETs, while remaining a distinct entity with specific profile. Assessment of potentially predictive biomarkers suggested efficacy of treatments usually active in foregut NETs. In conclusion, PHNETs display a foregut-like molecular profile distinct from other types of NETs, with recurrent molecular alterations. Upon exhaustive work-up to exclude unrecognized primary tumor, PHNETs should not be considered metastatic NETs from an unknown primary. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Louis de Mestier
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France.,Université de Paris, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - Rémy Nicolle
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France
| | - Nicolas Poté
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France.,Université de Paris, Department of Pathology, ENETS Centre of Excellence, Beaujon/Bichat Hospitals (APHP), Clichy/Paris, France
| | - Vinciane Rebours
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France.,Université de Paris, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - François Cauchy
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France.,Université de Paris, Department of Hepato-Bilio-Pancreatic Surgery, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - Olivia Hentic
- Université de Paris, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - Frédérique Maire
- Université de Paris, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - Maxime Ronot
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France.,Université de Paris, Department of Radiology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - Rachida Lebtahi
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France.,Université de Paris, Department of Nuclear Medicine, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - Alain Sauvanet
- Université de Paris, Department of Hepato-Bilio-Pancreatic Surgery, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - Valérie Paradis
- Université de Paris, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France.,Université de Paris, Department of Pathology, ENETS Centre of Excellence, Beaujon/Bichat Hospitals (APHP), Clichy/Paris, France
| | - Philippe Ruszniewski
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, France.,Université de Paris, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - Anne Couvelard
- Université de Paris, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France.,Université de Paris, Department of Pathology, ENETS Centre of Excellence, Beaujon/Bichat Hospitals (APHP), Clichy/Paris, France
| | - Jérôme Cros
- Université de Paris, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France.,Université de Paris, Department of Pathology, ENETS Centre of Excellence, Beaujon/Bichat Hospitals (APHP), Clichy/Paris, France
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20
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Borbath I, Pape UF, Deprez PH, Bartsch DK, Caplin M, Falconi M, Garcia-Carbonero R, Grozinsky-Glasberg S, Jensen RT, Arnold R, Ruszniewski P, Toumpanakis C, Valle JW, O Toole D. ENETS standardized (synoptic) reporting for endoscopy in neuroendocrine tumors. J Neuroendocrinol 2022; 34:e13105. [PMID: 35233848 DOI: 10.1111/jne.13105] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/27/2022] [Accepted: 02/05/2022] [Indexed: 02/06/2023]
Abstract
Despite efforts from various endoscopy societies, reporting in the field of endoscopy remains extremely heterogeneous. Harmonisation of clinical practice in endoscopy has been highlighted by application of many clinical practice guidelines and standards pertaining to the endoscopic procedures and reporting are underlined. The aim of the proposed "standardised reporting" is to (1) facilitate recognition of gastrointestinal neuroendocrine neoplasms (NEN) on initial endoscopy, (2) to enable interdisciplinary decision making for treatment by a multidisciplinary team, (3) to provide a basis for a standardised endoscopic follow-up which allows detection of recurrence or progression reliably, (4) to make endoscopic reports on NEN comparable between different units, and (5) to allow research collaboration between NEN centres in terms of consistency of their endoscopic data. The ultimate goal is to improve disease management, patient outcome and reduce the diagnostic burden on the side of the patient by ensuring the highest possible diagnostic accuracy and validity of endoscopic exams and possibly interventions.
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Affiliation(s)
- Ivan Borbath
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Ulrich-Frank Pape
- Department of Internal Medicine and Gastroenterology, Asklepios Klinik St. Georg, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
- Department of Hepatology and Gastroenterology, Charité Campus Mitte, Charité University Medicine Berlin, Berlin, Germany
| | - Pierre H Deprez
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Detlef Klaus Bartsch
- Department of Visceral-, Thoracic- and Vascular Surgery at the Philipps-University Marburg, Marburg, Germany
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital and University College London, London, UK
| | - Massimo Falconi
- Department of Surgery, San Raffaele Hospital IRCCS, Università Vita-e-Salute, Milan, Italy
| | | | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Division of Medicine, Endocrinology & Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Robert T Jensen
- Gastrointestinal Cell Biology Section, Digestive Disease Branch, National Institute of Health, Bethesda, Maryland, USA
| | - Rudolf Arnold
- Zentrum für Innere Medizin, Universitätsklinikum Marburg, Marburg, Germany
| | - Philippe Ruszniewski
- Department of Gastroenterology-Pancreatology, Beaujon Hospital and Université de Paris, Clichy, France
| | - C Toumpanakis
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital and University College London, London, UK
| | - Juan W Valle
- Department of Medical Oncology, University of Manchester/The Christie NHS Foundation Trust, Manchester, UK
| | - Dermot O Toole
- National Centre for Neuroendocrine Tumours, St Vincent's University Hospital and St James's Hospital and Trinity College Dublin, Dublin, Ireland
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21
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Le Bras M, Leclerc H, Rousseau O, Goudet P, Cuny T, Castinetti F, Bauters C, Chanson P, Tabarin A, Gaujoux S, Christin-Maitre S, Ruszniewski P, Borson-Chazot F, Guilhem I, Caron P, Goichot B, Beckers A, Delemer B, Raingeard I, Vergès B, Smati S, Wargny M, Cariou B, Hadjadj S. Pituitary adenoma in patients with multiple endocrine neoplasia type 1: a cohort study. Eur J Endocrinol 2021; 185:863-873. [PMID: 34636744 DOI: 10.1530/eje-21-0630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/07/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pituitary adenoma (PA) is one of the three major components of multiple endocrine neoplasia type 1 (MEN1). Recent studies have suggested that MEN1-associated PAs are less aggressive than initially estimated. We propose an analysis of the outcome of PAs with a standard of care treatment in a nationwide cohort of MEN1 patients. DESIGN Retrospective observational nationwide cohort study using the MEN1 patient registry from the French Group of Endocrine Tumours (GTE). METHODS The GTE database population consists of 1435 patients with MEN1. This analysis focused on 551 patients recruited after 2000 with at least 3 years of follow-up. The study outcome was tumour progression of PA defined by an increase in Hardy classification (HC) during follow-up according to referring physician regular reports. RESULTS Among 551 MEN1 patients (index and related), 202 (36.7%) had PA, with 114 (56.4%) diagnosed by MEN1-related screening. PAs were defined according to HC as microadenoma (grade I) in 117 cases (57.9%), macroadenoma in 59 (29.2%) with 20 HC grade II and 39 HC grades III-IV and unspecified in 26 (12.8%). They were prolactinomas in 92 cases (45.5%) and non-secreting in 73 (36.1%). After a median follow-up of 3 years among the 137 patients with HC grades I-II, 4 patients (2.9%) presented tumour progression. CONCLUSION PAs in patients with MEN1 are less aggressive than previously thought. Tumour progression is rare with a standard of care monitoring and treatment, especially in related patients who mostly present non-secreting microadenoma. MRI monitoring for asymptomatic MEN1 patients should be reduced accordingly.
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Affiliation(s)
- Maelle Le Bras
- CHU de Nantes PHU2 Institut du Thorax et du Système Nerveux, Service d'Endocrinologie, Diabétologie et Nutrition, Nantes, France
| | - Hélène Leclerc
- Centre Hospitalier de La Roche sur Yon, Department of Endocrinology and Diabetology, La Roche sur Yon, France
| | - Olivia Rousseau
- INSERM CIC 1413, Clinique des Données, CHU de Nantes, Nantes, France
| | - Pierre Goudet
- University Hospital Dijon, Endocrine Surgery, Hôpital du Bocage, Dijon, France
| | - Thomas Cuny
- Department of Endocrinology, Hopital de la Conception, Marseille, France
| | - Frederic Castinetti
- Aix-Marseille Université, Assistance-Publique-Hôpitaux de Marseille, Centre de Référence des Maladies Rares d'Origine Hypophysaire, Department of endocrinology, Marseille, France
| | | | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Endocrinology, Le Kremlin-Bicêtre, Île-de-France, France
| | - Antoine Tabarin
- Department of Endocrinology, Hôpital Haut Lévêque-CHU de Bordeaux, Pessac, France
| | | | | | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatology, Université Paris Diderot, Sorbonne Paris Cité, Beaujon Hospital, Paris Clichy, France
| | - Francoise Borson-Chazot
- Hospices Civils de Lyon, Fédération d'Endocrinologie Groupement Hospitalier Est, Lyon, France
| | - Isabelle Guilhem
- Centre Hospitalier Universitaire de Rennes, Hôpital Sud, Service d'Endocrinologie-Diabétologie-Nutrition, Rennes, France
| | - Philippe Caron
- CHU Toulouse, Endocrinology and Metabolic diseases, Service d'Endocrinologie, Toulouse, France
| | - Bernard Goichot
- Hôpital de Hautepierre, Service de Medecine Interne et Nutrition, Strasbourg Cedex, France
| | - Albert Beckers
- CHU de Liège, Service d'Endocrinologie, Domaine Univeritaire du Sart-Tilman, Liège, Belgium
| | - Brigitte Delemer
- Hôpital Robert-Debré, CHU de Reims, Service Endocrinologie, Reims, France
| | | | - Bruno Vergès
- CHU Dijon, Hôpital du Bocage, Endocrinologie, Diabétologie, Dijon, France
| | - Sarra Smati
- CHU de Nantes PHU2 Institut du Thorax et du Système Nerveux, Service d'Endocrinologie, Diabétologie et Nutrition, Nantes, France
- UNIV Nantes, CNRS, INSERM, CHU Nantes, l'Institut du Thorax, Nantes, France
| | - Matthieu Wargny
- CHU de Nantes PHU2 Institut du Thorax et du Système Nerveux, Service d'Endocrinologie, Diabétologie et Nutrition, Nantes, France
- UNIV Nantes, CNRS, INSERM, CHU Nantes, l'Institut du Thorax, Nantes, France
| | - Bertrand Cariou
- CHU de Nantes PHU2 Institut du Thorax et du Système Nerveux, Service d'Endocrinologie, Diabétologie et Nutrition, Nantes, France
- UNIV Nantes, CNRS, INSERM, CHU Nantes, l'Institut du Thorax, Nantes, France
| | - Samy Hadjadj
- CHU de Nantes PHU2 Institut du Thorax et du Système Nerveux, Service d'Endocrinologie, Diabétologie et Nutrition, Nantes, France
- UNIV Nantes, CNRS, INSERM, CHU Nantes, l'Institut du Thorax, Nantes, France
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22
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Passemard S, Faye A, Dubertret C, Peyre H, Vorms C, Boimare V, Auvin S, Flamant M, Ruszniewski P, Ricard JD. Covid-19 crisis impact on the next generation of physicians: a survey of 800 medical students. BMC Med Educ 2021; 21:529. [PMID: 34645453 PMCID: PMC8511858 DOI: 10.1186/s12909-021-02955-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 09/15/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND Many initiatives have emerged worldwide to handle the surge of hospitalizations during the SARS-CoV-2 pandemic. In France, the University of Paris North called on its medical students, whose status makes them integral members of the healthcare staff, to volunteer in their capacity of medical students and/or as nurses/nursing aids in understaffed intensive care units and other Covid-19 services. We attempted to evaluate their commitment, whether the pandemic affected their certainty for the medical profession and career choices, and how they scored their sadness and anxiety levels. METHODS The University of Paris North took a weekly official census of the involvement of 1205 4th-6th year medical students during the first lockdown in France. Six weeks after the lockdown began (May 4th), an e-questionnaire was sent to 2145 2nd-6th year medical students. The survey lasted 4 weeks and documented volunteering by medical students, the association between the pandemic and certainty for their profession, their choice of medical specialty and factors that influenced sadness and anxiety scores. RESULTS 82% of 4th-6th year medical students volunteered to continue their internship or be reassigned to COVID-19 units. Of 802 2nd-6th year students who completed the e-questionnaire, 742 (93%) volunteered in Covid-19 units, of which half acted as nurses. This engagement reinforced the commitment of 92% of volunteers to become physicians. However, at the peak of the outbreak, 17% had doubts about their ability to be physicians, while 12% reconsidered their choice of future specialty. Finally, 38% of students reported a score of 7/10 or more on the sadness scale, and 43% a score of 7/10 or more for anxiety. Neither study year nor service influenced sadness or anxiety scores. However, gender influenced both, with women scoring significantly higher than men (p < 0.0001). CONCLUSION Medical students of the University of Paris North who made an early and unconditional commitment to help hospital staff handle the pandemic constituted a powerful healthcare reserve force during the crisis. Although the vast majority remained convinced that they want to become physicians, this experience came at a significant psychological cost, especially for women. Alleviating this cost would improve future crisis responses.
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Affiliation(s)
- Sandrine Passemard
- Université de Paris, APHP, Hôpital Robert Debré, DMU INOV-RDB, Service de Neurologie Pédiatrique, NEURODIDEROT, UMR 1141 INSERM, Paris, France.
| | - Albert Faye
- Université de Paris, APHP, Hôpital Robert Debré, DMU DM'UP, Service de Pédiatrie Générale, ECEVE, UMR 1123 INSERM, Paris, France
| | - Caroline Dubertret
- Université de Paris, APHP, Hôpital Louis Mourier, DMU ESPRIT, Service de Psychiatrie, UMR 1266 INSERM, Colombes, France
| | - Hugo Peyre
- Université de Paris, APHP, Hôpital Robert Debré, DMU INOV-RDB, Service de Psychiatrie de l'enfant, NEURODIDEROT, UMR 1141 INSERM, Paris, France
| | | | | | - Stéphane Auvin
- Université de Paris, APHP, Hôpital Robert Debré, DMU INOV-RDB, Service de Neurologie Pédiatrique, NEURODIDEROT, UMR 1141 INSERM, Paris, France
- Institut Universitaire de France (IUF), Paris, France
| | - Martin Flamant
- Université de Paris, APHP, Hôpital Bichat, DMU DREAM, Service d'Explorations fonctionnelles, Physiologie, Centre du Sommeil, CRI, UMR1149, Paris, France
| | - Philippe Ruszniewski
- Université de Paris, APHP, Hôpital Beaujon, DMU DIGEST, Service de Pancréatologie et Oncologie Digestive, Hôpital Beaujon, CRI, UMR 1149 INSERM, Clichy, France
| | - Jean-Damien Ricard
- Université de Paris, APHP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, IAME, UMR 1137 INSERM, Colombes, France.
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23
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Pavel M, Ćwikła JB, Lombard-Bohas C, Borbath I, Shah T, Pape UF, Capdevila J, Panzuto F, Truong Thanh XM, Houchard A, Ruszniewski P. Efficacy and safety of high-dose lanreotide autogel in patients with progressive pancreatic or midgut neuroendocrine tumours: CLARINET FORTE phase 2 study results. Eur J Cancer 2021; 157:403-414. [PMID: 34597974 DOI: 10.1016/j.ejca.2021.06.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This prospective, single-arm, phase 2 study assessed the efficacy and safety of lanreotide autogel (LAN) administered at a reduced dosing interval in patients with progressive neuroendocrine tumours (NETs) after LAN standard regimen. METHODS Patients had metastatic or locally advanced, grade 1 or 2 midgut NETs or pancreatic NETs (panNETs) and centrally assessed disease progression on LAN 120 mg every 28 days. They were treated with LAN 120 mg every 14 days for up to 96 weeks (midgut cohort) or 48 weeks (panNET cohort). The primary end-point was centrally assessed progression-free survival (PFS). PFS by Ki-67 categories was analysed post hoc. Secondary end-points included quality of life (QoL) and safety. RESULTS Ninety-nine patients were enrolled (midgut, N = 51; panNET, N = 48). Median (95% CI) PFS was 8.3 (5.6-11.1) and 5.6 (5.5-8.3) months, respectively. In patients with Ki-67 ≤ 10%, median (95% CI) PFS was 8.6 (5.6-13.8) and 8.0 (5.6-8.3) months in the midgut and panNET cohorts, respectively. Patients' QoL did not deteriorate during the study. There were no treatment-related serious adverse events and only two withdrawals for treatment-related adverse events (both in the panNET cohort). CONCLUSIONS In patients with progressive NETs following standard-regimen LAN, reducing the dosing interval to every 14 days provided encouraging PFS, particularly in patients with a Ki-67 ≤ 10% (post hoc); no safety concerns and no deterioration in QoL were observed. Increasing LAN dosing frequency could therefore be considered before escalation to less well-tolerated therapies.
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Affiliation(s)
- Marianne Pavel
- Department of Medicine 1, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - Jaroslaw B Ćwikła
- University of Warmia and Mazury, Olsztyn, Poland; Diagnostic and Therapeutic Center - Gammed, Warsaw, Poland
| | | | - Ivan Borbath
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Tahir Shah
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ulrich F Pape
- Charité - Universitätsmedizin Berlin, Berlin, Germany; Asklepios Klinik St Georg, Asklepios Tumourzentrum Hamburg, Asklepios Medical School, Hamburg, Germany
| | - Jaume Capdevila
- Vall Hebron University Hospital and Vall Hebron Institute of Oncology, Barcelona, Spain
| | - Francesco Panzuto
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence Rome, Rome, Italy
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24
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Lacombe C, Perrier M, Hentic O, Brixi H, Rebours V, Cadiot G, Ruszniewski P, de Mestier L. 568P FOLFOX-bevacizumab chemotherapy in patients with progressive metastatic neuroendocrine tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Vullierme MP, Ruszniewski P, de Mestier L. Are recist criteria adequate in assessing the response to therapy in metastatic NEN? Rev Endocr Metab Disord 2021; 22:637-645. [PMID: 33871762 DOI: 10.1007/s11154-021-09645-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
Response to therapy criteria, known as RECIST (Response Evaluation Criteria in Solid Tumours), are widely used to evaluate neuroendocrine tumours (NET) metastatic to the liver, under treatment. RECIST criteria does not take in account many various distinct features such as tumour growth, secretory capacity and anatomical localisation with wide variation in clinical and biological presentation of different NETs. Key features of RECIST includes definitions of the minimal size of measurable lesions, instructions on how many lesions to measure and follow, and the use of unidimensional, rather than bidimensional, measures for overall evaluation of tumour burden. These measures are currently done with computed tomography (CT) or Magnetic Resonance Imaging (MRI). RECIST criteria are accurate in assessing tumour progression but sometimes inaccurate in assessing tumour response after locoregional therapy or under molecular targeted therapy, tumour vessels being part of the target of such treatments. There is poor correlation between a so called tumour necrosis and conventional methods of response assessment, which poses questions of how best to quantify efficacy of these targeted therapies. Variations in tumour density with computed tomography (CT) could theoretically be associated with tumour necrosis. This hypothesis has been studied proposing alternative CT criteria of response evaluation in metastatic digestive NET treated with targeted therapy. If preliminary results upon the poor relationship between density measured with CT (derived from CHOI criteria) evolution curves at CT and PFS are confirmed by further studies, showing that the correlation between density changing and response to non-targeted treatment is weak, the use of contrast injection, will probably be not mandatory to enable appropriate evaluation.
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Affiliation(s)
- Marie-Pierre Vullierme
- Department of Radiology, University Hospitals Paris-Nord Val-de-Seine, AP-HP, Beaujon, 92110, Clichy, France.
- Université Paris Diderot-Paris 7, University of Paris, 75018, Clichy, France.
| | - Philippe Ruszniewski
- Department of Pancreatology, University Hospitals Paris-Nord Val-de-Seine, AP-HP, Beaujon, 92110, Clichy, France
- Université Paris Diderot-Paris 7, University of Paris, 75018, Clichy, France
| | - Louis de Mestier
- Department of Pancreatology, University Hospitals Paris-Nord Val-de-Seine, AP-HP, Beaujon, 92110, Clichy, France
- Université Paris Diderot-Paris 7, University of Paris, 75018, Clichy, France
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26
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Strosberg J, Caplin M, Kunz P, Ruszniewski P, Bodei L, Hendifar A, Mittra E, Wolin E, Yao J, Pavel M, Grande Pulido E, Van Cutsem E, Seregni E, Duarte H, Gericke G, Bartalotta A, Demange A, Mutevelic S, Krenning E. O-2 Overall survival and long-term safety data from the NETTER-1 trial: 177-Lu-Dotatate vs. high-dose octreotide in patients with progressive midgut NETs. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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27
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De Rycke O, Walter T, Perrier M, Hentic O, Lombard-Bohas C, Coriat R, Cadiot G, Couvelard A, Ruszniewski P, Cros J, de Mestier L. Alkylating agent rechallenge in metastatic pancreatic neuroendocrine tumors. Endocr Relat Cancer 2021; 28:457-466. [PMID: 33979778 DOI: 10.1530/erc-21-0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/12/2021] [Indexed: 11/08/2022]
Abstract
A rechallenge is common after the initial efficacy of alkylating-based chemotherapy (ALK) in pancreatic neuroendocrine tumors (PanNET). High MGMT expression seems associated with a lower response to ALK. We aimed to evaluate the efficacy and toxicity of ALK rechallenge in PanNET, and to assess the evolution of MGMT expression under ALK. All consecutive patients with advanced PanNETs who received initial ALK (achieving tumor control) followed by a pause of > 3 months, then an ALK rechallenge (ALK2) upon progression were retrospectively studied (cohort A). The primary endpoint was progression-free survival under ALK2 (PFS2). The MGMT expression was retrospectively assessed by immunohistochemistry (H-score) in consecutive PanNET surgically resected following ALK (cohort B). We found that Cohort A included 62 patients (median Ki67 8%), for whom ALK1 followed by a pause achieved an objective response rate of 55% and a PFS1 of 23.7 months (95% IC, 19.8-27.6). ALK2 achieved no objective response and stability in 62% of patients. The median PFS2 was 9.2 months (IC 95% 7.1-11.3). At multivariable analysis, a hormonal syndrome (P = 0.032) and a pause longer than 12 months (P = 0.041) were associated with a longer PFS2. In cohort B (17 patients), the median MGMT H-score increased from 45 (IQR 18-105) before ALK to 100 (IQR 56-180) after ALK (P = 0.003). We conclude that after the initial efficacy of ALK treatment, a pause followed by ALK rechallenge might be appropriate to prolong tumor control, improve quality of life and limit long-term adverse events. Increased MGMT expression under ALK might explain the low efficacy of ALK rechallenge.
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Affiliation(s)
- Ophélie De Rycke
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, Paris, France
| | - Thomas Walter
- Department of Gastro-enterology and oncology, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
| | - Marine Perrier
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré University Hospital, Reims, France
| | - Olivia Hentic
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital, Clichy, France
| | - Catherine Lombard-Bohas
- Department of Gastro-enterology and oncology, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
| | - Romain Coriat
- Department of Gastroenterology, Cochin University Hospital, Paris, France
| | - Guillaume Cadiot
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré University Hospital, Reims, France
| | - Anne Couvelard
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, Paris, France
- Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon University Hospital, Paris/Clichy, France
| | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, Paris, France
| | - Jérôme Cros
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, Paris, France
- Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon University Hospital, Paris/Clichy, France
| | - Louis de Mestier
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, Paris, France
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Dioguardi Burgio M, Cros J, Panvini N, Depoilly T, Couvelard A, Ruszniewski P, de Mestier L, Hentic O, Sauvanet A, Dokmak S, Faccinetto A, Ronot M, Vilgrain V. Serotonin immunoreactive pancreatic neuroendocrine neoplasm associated with main pancreatic duct dilation: a recognizable entity with excellent long-term outcome. Eur Radiol 2021; 31:8671-8681. [PMID: 33977308 DOI: 10.1007/s00330-021-08007-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/19/2021] [Accepted: 04/20/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Dilatation of the main pancreatic duct (MPD) is rare in pancreatic neuroendocrine neoplasm (panNEN) and may be due to different mechanisms. We compared the imaging and pathological characteristics as well as the outcome after resection of positive (S+) and negative (S-) serotonin immunoreactive panNENs causing MPD dilatation. METHODS This retrospective study included patients with panNEN, with MPD dilatation (≥ 4 mm) on preoperative CT/MRI and resected between 2005 and 2019. Clinical, radiological, and pathological features were compared between S+ and S- panNENs. Imaging features associated with S+ panNEN were identified using logistic regression analysis. The diagnostic performance of imaging for the differentiation of S+ and S- panNENs was assessed by ROC curve analysis. Recurrence-free survival (RFS) was compared between the two groups. RESULTS The final population of 60 panNENs included 20/60 (33%) S+ panNENs. S+ panNENs were smaller (median 12.5 mm vs. 33 mm; p < 0.01), more frequently hyperattenuating/intense on portal venous phase at CT/MRI (95% vs. 25%, p < 0.01), and presented with more fibrotic stroma on pathology (60.7 ± 16% vs. 40.7 ± 12.8%; p < 0.01) than S- panNENs. Tumor size was the only imaging factor associated with S+ panNEN on multivariate analysis. A tumor size ≤ 20 mm had 95% sensitivity and 90% specificity for the diagnosis of S+ panNEN. Among 52 patients without synchronous liver metastases, recurrence occurred in 1/20 (5%) with S+ panNEN and 18/32 (56%) with S- panNEN (p < 0.01). Median RFS was not reached in S+ panNENs and was 31.3 months in S- panNENs (p < 0.01). CONCLUSIONS In panNENs with MPD dilatation, serotonin positivity is associated with smaller size, extensive fibrotic stroma, and better long-term outcomes. KEY POINTS • S+ panNENs showed a higher percentage of fibrotic stroma, higher microvessel density, and lower proliferation index (Ki-67) compared to S- panNENs. • Radiologically, S+ panNENs causing dilatation of the MPD were characterized by a small size (< = 20 mm) and a persistent enhancement on portal phase on both CT and MRI. • Patients with S+ panNENs presented with longer RFS when compared to those with S- panNENs.
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Affiliation(s)
- Marco Dioguardi Burgio
- Université de Paris, INSERM U1149 "centre de recherche sur l'inflammation," CRI, F-75018, Paris, France.
- Department of Radiology, AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
| | - Jérome Cros
- Department of Pathology, AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Nicola Panvini
- Department of Radiology, AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Thomas Depoilly
- Department of Pathology, AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Anne Couvelard
- Department of Pathology, AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Philippe Ruszniewski
- Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Louis de Mestier
- Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Olivia Hentic
- Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Alain Sauvanet
- Department of HBP Surgery, AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Safi Dokmak
- Department of HBP Surgery, AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Alex Faccinetto
- Department of Radiology, AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Maxime Ronot
- Université de Paris, INSERM U1149 "centre de recherche sur l'inflammation," CRI, F-75018, Paris, France
- Department of Radiology, AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Valérie Vilgrain
- Université de Paris, INSERM U1149 "centre de recherche sur l'inflammation," CRI, F-75018, Paris, France
- Department of Radiology, AP-HP Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
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Strosberg JR, Srirajaskanthan R, El-Haddad G, Wolin EM, Chasen BA, Kulke MH, Bushnell DL, Caplin ME, Baum RP, Hendifar AE, Öberg K, Ruszniewski P, Santoro P, Broberg P, Leeuwenkamp OR, Krenning EP. Symptom Diaries of Patients with Midgut Neuroendocrine Tumors Treated with 177Lu-DOTATATE. J Nucl Med 2021; 62:jnumed.120.258897. [PMID: 33771903 PMCID: PMC8612179 DOI: 10.2967/jnumed.120.258897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
We report the impact of 177Lu DOTATATE treatment on abdominal pain, diarrhea, and flushing, symptoms that patients with advanced midgut neuroendocrine tumors (NETs) often find burdensome. Methods: All patients enrolled in the international randomized phase 3 Neuroendocrine Tumors Therapy (NETTER-1) trial (177Lu-DOTATATE plus standard-dose octreotide long-acting repeatable [LAR], n = 117; high-dose octreotide LAR, n = 114) were asked to record the occurrence of predefined symptoms in a daily diary. Change from baseline in symptom scores (mean number of days with a symptom) was analyzed using a mixed model for repeated measures. Results: Patients (intent-to-treat) who received 177Lu-DOTATATE experienced a significantly greater decline from baseline in symptom scores than patients who received high-dose octreotide LAR. For 177Lu-DOTATATE, the mean decline in days with abdominal pain, diarrhea, and flushing was 4.10, 4.55, and 4.52 days per 4 weeks, respectively, compared with 0.99, 1.44, and 2.54 days for high-dose octreotide LAR. The mean differences were 3.11 days (95% confidence interval, 1.35-4.88; P = 0.0007) for abdominal pain, 3.11 days (1.18-5.04; P = 0.0017) for diarrhea, and 1.98 days (0.08-3.88; P = 0.0413) for flushing, favoring 177Lu-DOTATATE. A positive repeated measures correlation was found between diary-recorded symptom scores and questionnaire-recorded pain, diarrhea, and flushing. Conclusion: In addition to efficacy and quality of life benefits, symptom diaries from NETTER-1 demonstrated that treatment with 177Lu DOTATATE was associated with statistically significant reductions in abdominal pain, diarrhea, and flushing, constituting the core symptoms of patients with progressive midgut NETs, compared with high-dose octreotide LAR, supporting a beneficial effect of 177Lu DOTATATE on HRQoL.
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Affiliation(s)
| | | | | | - Edward M. Wolin
- Center for Carcinoid and Neuroendocrine Tumors, Tish Cancer Institute at Mount Sinai, New York, New York
| | - Beth A. Chasen
- Department of Nuclear Medicine, Division of Diagnostic Imaging, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
| | - Matthew H. Kulke
- Section of Hematology and Medical Oncology, Boston University and Boston Medical Center, Boston, Massachusetts
| | | | - Martyn E. Caplin
- Neuroendocrine Tumour Unit, Royal Free Hospital, London, United Kingdom
| | - Richard P. Baum
- Curanosticum Wiesbaden-Frankfurt, DKD Helios Clinic, Wiesbaden, Germany
| | - Andrew E. Hendifar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kjell Öberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Paola Santoro
- Advanced Accelerator Applications, Millburn, New Jersey
| | - Per Broberg
- Advanced Accelerator Applications, Geneva, Switzerland; and
| | | | - Eric P. Krenning
- Cyclotron Rotterdam BV, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - for the NETTER-1 study group
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Neuroendocrine Tumour Unit, Department of Gastroenterology, King’s College Hospital, London, United Kingdom
- Center for Carcinoid and Neuroendocrine Tumors, Tish Cancer Institute at Mount Sinai, New York, New York
- Department of Nuclear Medicine, Division of Diagnostic Imaging, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
- Section of Hematology and Medical Oncology, Boston University and Boston Medical Center, Boston, Massachusetts
- Department of Radiology, University of Iowa, Iowa City, Iowa
- Neuroendocrine Tumour Unit, Royal Free Hospital, London, United Kingdom
- Curanosticum Wiesbaden-Frankfurt, DKD Helios Clinic, Wiesbaden, Germany
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Division of Gastroenterology and Pancreatology, Hôpital Beaujon, Clichy, France
- Advanced Accelerator Applications, Millburn, New Jersey
- Advanced Accelerator Applications, Geneva, Switzerland; and
- Cyclotron Rotterdam BV, Erasmus University Medical Center, Rotterdam, The Netherlands
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30
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Ambrosini V, Kunikowska J, Baudin E, Bodei L, Bouvier C, Capdevila J, Cremonesi M, de Herder WW, Dromain C, Falconi M, Fani M, Fanti S, Hicks RJ, Kabasakal L, Kaltsas G, Lewington V, Minozzi S, Cinquini M, Öberg K, Oyen WJG, O'Toole D, Pavel M, Ruszniewski P, Scarpa A, Strosberg J, Sundin A, Taïeb D, Virgolini I, Wild D, Herrmann K, Yao J. Consensus on molecular imaging and theranostics in neuroendocrine neoplasms. Eur J Cancer 2021; 146:56-73. [PMID: 33588146 DOI: 10.1016/j.ejca.2021.01.008] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
Nuclear medicine plays an increasingly important role in the management neuroendocrine neoplasms (NEN). Somatostatin analogue (SSA)-based positron emission tomography/computed tomography (PET/CT) and peptide receptor radionuclide therapy (PRRT) have been used in clinical trials and approved by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA). European Association of Nuclear Medicine (EANM) Focus 3 performed a multidisciplinary Delphi process to deliver a balanced perspective on molecular imaging and radionuclide therapy in well-differentiated neuroendocrine tumours (NETs). NETs form in cells that interact with the nervous system or in glands that produce hormones. These cells, called neuroendocrine cells, can be found throughout the body, but NETs are most often found in the abdomen, especially in the gastrointestinal tract. These tumours may also be found in the lungs, pancreas and adrenal glands. In addition to being rare, NETs are also complex and may be difficult to diagnose. Most NETs are non-functioning; however, a minority present with symptoms related to hypersecretion of bioactive compounds. NETs often do not cause symptoms early in the disease process. When diagnosed, substantial number of patients are already found to have metastatic disease. Several societies' guidelines address Neuroendocrine neoplasms (NENs) management; however, many issues are still debated, due to both the difficulty in acquiring strong clinical evidence in a rare and heterogeneous disease and the different availability of diagnostic and therapeutic options across countries. EANM Focus 3 reached consensus on employing 68gallium-labelled somatostatin analogue ([68Ga]Ga-DOTA-SSA)-based PET/CT with diagnostic CT or magnetic resonance imaging (MRI) for unknown primary NET detection, metastatic NET, NET staging/restaging, suspected extra-adrenal pheochromocytoma/paraganglioma and suspected paraganglioma. Consensus was reached on employing 18fluorine-fluoro-2-deoxyglucose ([18F]FDG) PET/CT in neuroendocrine carcinoma, G3 NET and in G1-2 NET with mismatched lesions (CT-positive/[68Ga]Ga-DOTA-SSA-negative). Peptide receptor radionuclide therapy (PRRT) was recommended for second line treatment for gastrointestinal NET with [68Ga]Ga-DOTA-SSA uptake in all lesions, in G1/G2 NET at disease progression, and in a subset of G3 NET provided all lesions are positive at [18F]FDG and [68Ga]Ga-DOTA-SSA. PRRT rechallenge may be used for in patients with stable disease for at least 1 year after therapy completion. An international consensus is not only a prelude to a more standardised management across countries but also serves as a guide for the direction to follow when designing new research studies.
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Affiliation(s)
- Valentina Ambrosini
- IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Nuclear Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Eric Baudin
- Endocrine Oncolgy Unit, Institut Gustave Roussy, Villejuif Cedex, France
| | - Lisa Bodei
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Catherine Bouvier
- International Neuroendocrine Cancer Alliance (INCA), Leamington Spa, UK
| | - Jaume Capdevila
- Medical Oncology Department, Vall Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Marta Cremonesi
- Radiation Research Unit, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Wouter W de Herder
- Erasmus MC & Erasmus MC Cancer Center, ENETS Center of Excellence Rotterdam, Rotterdam, the Netherlands
| | | | - Massimo Falconi
- Pancreas Translational & Research Institute, Scientific Institute San Raffaele Hospital and University Vita-Salute, Milan, Italy
| | - Melpomeni Fani
- Division of Radiopharmaceutical Chemistry, University Hospital Basel, Basel, Switzerland
| | - Stefano Fanti
- IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Nuclear Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Rodney J Hicks
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Levent Kabasakal
- Istanbul University-Cerrahpaşa, Faculty of Medicine, Department of Nuclear Medicine, Turkey
| | - Gregory Kaltsas
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Silvia Minozzi
- Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Michela Cinquini
- Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Kjell Öberg
- Dept of Endocrine Oncology, University Hospital Uppsala, Sweden
| | - Wim J G Oyen
- Humanitas University and Humanitas Clinical and Research Center, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital Arnhem, the Netherlands
| | | | - Marianne Pavel
- Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philippe Ruszniewski
- Department of Pancreatology, Beaujon Hospital, Université de Paris, Clichy, France
| | - Aldo Scarpa
- ARC-NET Centre for Applied Research on Cancer and Department of Pathology, University of Verona, Italy
| | | | - Anders Sundin
- Department of Surgical Sciences, Uppsala University, University Hospital, Sweden
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Damian Wild
- Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Ken Herrmann
- Department of Nuclear Medicine, Universitätsklinikum, Essen, Germany.
| | - James Yao
- Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lacombe C, De Rycke O, Couvelard A, Turpin A, Cazes A, Hentic O, Gounant V, Zalcman G, Ruszniewski P, Cros J, de Mestier L. Biomarkers of Response to Etoposide-Platinum Chemotherapy in Patients with Grade 3 Neuroendocrine Neoplasms. Cancers (Basel) 2021; 13:643. [PMID: 33562726 PMCID: PMC7915900 DOI: 10.3390/cancers13040643] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 12/18/2022] Open
Abstract
Etoposide-platinum (EP) chemotherapy has long been the reference treatment for grade 3 neuroendocrine neoplasms (G3 NEN). However, G3 NEN are heterogeneous, including well-differentiated tumors (NET) and poorly differentiated large (LCNEC) or small (SCNEC) cell carcinomas, whose response to EP chemotherapy varies considerably. Our aim was to evaluate predictive biomarkers for the response to EP chemotherapy in G3 NEN. We retrospectively studied 89 patients with lung (42%) and digestive (58%) G3 NEN treated by EP chemotherapy between 2006 and 2020. All cases were centrally reviewed for cytomorphology/Ki-67 and immunohistochemistry of retinoblastoma protein (Rb)/p53/p16, analyzed using a semi-quantitative score. The absence of Rb staining (Rbinap) or the absence of very intense p53 staining (p53inap) were considered inappropriate. Rb staining was also studied as a quantitative marker, the best threshold being determined by ROC curve. Intense p16 staining (p16high) also suggested cell cycle dysregulation. Our primary endpoint was the objective response rate (ORR). We included 10 G3 NET, 31 LCNEC and 48 SCNEC, which showed ORR of 20%, 32% and 75%, respectively (NET vs. NEC, p = 0.040; LCNEC vs. SCNEC, p < 0.001). The ORR was significantly higher in NEN presenting with Rbinap (63% vs. 42%, p = 0.025) and p16high (66% vs. 35%, p = 0.006). Rb < 150 optimally identified responders (AUC = 0.657, p < 0.001). The ORR was 67% in Rb < 150 (vs. 25%, p = 0.005). On multivariate analysis, only Rb < 150 was independently associated with ORR (OR 4.16, 95% CI 1.11-15.53, p = 0.034). We confirm the heterogeneity of the response to EP treatment in G3 NEN. Rb < 150 was the best predictive biomarker for the response to EP, and p53 immunostaining had no additional value.
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Affiliation(s)
- Caroline Lacombe
- Université de Paris, Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), 92110 Clichy, France; (C.L.); (O.D.R.); (O.H.); (P.R.)
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, 75018 Paris, France; (A.C.); (J.C.)
| | - Ophélie De Rycke
- Université de Paris, Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), 92110 Clichy, France; (C.L.); (O.D.R.); (O.H.); (P.R.)
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, 75018 Paris, France; (A.C.); (J.C.)
| | - Anne Couvelard
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, 75018 Paris, France; (A.C.); (J.C.)
- Université de Paris, Department of Pathology, ENETS Centre of Excellence, Beaujon/Bichat University Hospital (APHP), 75018 Paris, France;
| | - Anthony Turpin
- Department of Medical Oncology, Claude Huriez University Hospital, 59000 Lille, France;
| | - Aurélie Cazes
- Université de Paris, Department of Pathology, ENETS Centre of Excellence, Beaujon/Bichat University Hospital (APHP), 75018 Paris, France;
| | - Olivia Hentic
- Université de Paris, Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), 92110 Clichy, France; (C.L.); (O.D.R.); (O.H.); (P.R.)
| | - Valérie Gounant
- Université de Paris, Department of Thoracic Oncology, CIC INSERM 1425, Bichat University Hospital, 75018 Paris, France; (V.G.); (G.Z.)
| | - Gérard Zalcman
- Université de Paris, Department of Thoracic Oncology, CIC INSERM 1425, Bichat University Hospital, 75018 Paris, France; (V.G.); (G.Z.)
| | - Philippe Ruszniewski
- Université de Paris, Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), 92110 Clichy, France; (C.L.); (O.D.R.); (O.H.); (P.R.)
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, 75018 Paris, France; (A.C.); (J.C.)
| | - Jérôme Cros
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, 75018 Paris, France; (A.C.); (J.C.)
- Université de Paris, Department of Pathology, ENETS Centre of Excellence, Beaujon/Bichat University Hospital (APHP), 75018 Paris, France;
| | - Louis de Mestier
- Université de Paris, Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), 92110 Clichy, France; (C.L.); (O.D.R.); (O.H.); (P.R.)
- Université de Paris, Centre of Research on Inflammation, INSERM U1149, 75018 Paris, France; (A.C.); (J.C.)
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Caplin ME, Pavel M, Phan AT, Ćwikła JB, Sedláčková E, Thanh XMT, Wolin EM, Ruszniewski P. Lanreotide autogel/depot in advanced enteropancreatic neuroendocrine tumours: final results of the CLARINET open-label extension study. Endocrine 2021; 71:502-513. [PMID: 33052555 PMCID: PMC7881960 DOI: 10.1007/s12020-020-02475-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE In the phase III CLARINET study (NCT00353496), lanreotide autogel/depot (lanreotide) significantly improved progression-free survival (PFS) vs placebo in patients with non-functioning intestinal or pancreatic neuroendocrine tumours (NETs). The aim of CLARINET open-label extension (OLE) (NCT00842348) was to evaluate long-term safety and efficacy of lanreotide in these patients. METHODS Patients from the CLARINET study were eligible for the OLE if they had stable disease (irrespective of treatment group) or progressive disease (PD) (placebo-treated patients only). All patients in the OLE received lanreotide 120 mg every 28 days. Computed tomography or magnetic resonance imaging scans were conducted every 6 months and assessed locally for PD (the final scan was also assessed centrally). RESULTS Overall, 89 patients took part in the OLE (lanreotide, n = 42; placebo, n = 47). Median (range) exposure to lanreotide in patients who received lanreotide in the core study and OLE (LAN-LAN group) was 59.0 (26.0-102.3) months. In this group, the overall incidences of adverse events (AEs) and treatment-related AEs were lower in the OLE than in the core study. Median [95% CI] PFS in the LAN-LAN group was 38.5 [30.9; 59.4] months. In placebo-treated patients with PD at the end of the core study, time to death or subsequent PD during the OLE was 19 [10.1; 26.7] months. CONCLUSIONS This study provides new evidence on the long-term safety profile and sustained anti-tumour effects of lanreotide autogel/depot in indolent and progressive metastatic intestinal or pancreatic NETs.
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Affiliation(s)
- Martyn E Caplin
- Department of Gastroenterology and Tumour Neuroendocrinology, Royal Free Hospital, London, UK.
| | - Marianne Pavel
- Department of Medicine, Division of Endocrinology and Diabetology, Universitätsklinikum Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Alexandria T Phan
- Department of Hematology-Oncology, University of Texas Health Science Center at Tyler, Tyler, TX, USA
- Cancer Treatment Centers of America at South Eastern Regional Center, Atlanta, GA, USA
| | - Jarosław B Ćwikła
- Department of Cardiology and Cardiac Surgery, School of Medicine, University of Warmia and Mazury, Olsztyn, Poland
- Diagnostic and Therapeutic Center - Gammed, Warsaw, Poland
| | - Eva Sedláčková
- Department of Oncology, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic
| | | | - Edward M Wolin
- Tisch Cancer Institute at Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Carcinoid and Neuroendocrine Tumors, New York, NY, USA
| | - Philippe Ruszniewski
- Division of Gastroenterology and Pancreatology, Beaujon Hospital, Clichy, France
- Université de Paris, Paris, France
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Matet A, Fournel L, Gaillard F, Amar L, Arlet JB, Baron S, Bats AS, Buffel du Vaure C, Charlier C, De Lastours V, Faye A, Jablon E, Kadlub N, Leguen J, Lebeaux D, Malmartel A, Mirault T, Planquette B, Régent A, Thebault JL, Dinh AT, Nuzzo A, Turc G, Friedlander G, Ruszniewski P, Badoual C, Ranque B, Oualha M, Courbebaisse M. Impact of integrating objective structured clinical examination into academic student assessment: Large-scale experience in a French medical school. PLoS One 2021; 16:e0245439. [PMID: 33444375 PMCID: PMC7808634 DOI: 10.1371/journal.pone.0245439] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/01/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Objective structured clinical examinations (OSCE) evaluate clinical reasoning, communication skills, and interpersonal behavior during medical education. In France, clinical training has long relied on bedside clinical practice in academic hospitals. The need for a simulated teaching environment has recently emerged, due to the increasing number of students admitted to medical schools, and the necessity of objectively evaluating practical skills. This study aimed at investigating the relationships between OSCE grades and current evaluation modalities. Methods Three-hundred seventy-nine 4th-year students of University-of-Paris Medical School participated to the first large-scale OSCE at this institution, consisting in three OSCE stations (OSCE#1–3). OSCE#1 and #2 focused on cardiovascular clinical skills and competence, whereas OSCE#3 focused on relational skills while providing explanations before planned cholecystectomy. We investigated correlations of OSCE grades with multiple choice (MCQ)-based written examinations and evaluations of clinical skills and behavior (during hospital traineeships); OSCE grade distribution; and the impact of integrating OSCE grades into the current evaluation in terms of student ranking. Results The competence-oriented OSCE#1 and OSCE#2 grades correlated only with MCQ grades (r = 0.19, P<0.001) or traineeship skill grades (r = 0.17, P = 0.001), respectively, and not with traineeship behavior grades (P>0.75). Conversely, the behavior-oriented OSCE#3 grades correlated with traineeship skill and behavior grades (r = 0.19, P<0.001, and r = 0.12, P = 0.032), but not with MCQ grades (P = 0.09). The dispersion of OSCE grades was wider than for MCQ examinations (P<0.001). When OSCE grades were integrated to the final fourth-year grade with an incremental 10%, 20% or 40% coefficient, an increasing proportion of the 379 students had a ranking variation by ±50 ranks (P<0.001). This ranking change mainly affected students among the mid-50% of ranking. Conclusion This large-scale French experience showed that OSCE designed to assess a combination of clinical competence and behavioral skills, increases the discriminatory capacity of current evaluations modalities in French medical schools.
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Affiliation(s)
- Alexandre Matet
- Université de Paris, Faculté de Médecine, Paris, France
- Centre de Recherche des Cordeliers, INSERM UMR1138, Paris, France
- Service d’ophtalmologie, Institut Curie, Paris, France
- * E-mail:
| | - Ludovic Fournel
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM UMR1124, Paris, France
- Service de chirurgie thoracique, AP-HP, Hôpital Cochin, Paris, France
| | - François Gaillard
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Laurence Amar
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Département d’hypertension artérielle, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Benoit Arlet
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Médecine interne, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Stéphanie Baron
- Université de Paris, Faculté de Médecine, Paris, France
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne-Sophie Bats
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM UMR-S 1147, Paris, France
- Service de gynécologie oncologique et de chirurgie du sein, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Celine Buffel du Vaure
- Département de médecine générale, Université de Paris, Faculté de Médecine, Paris, France
| | - Caroline Charlier
- Université de Paris, Faculté de Médecine, Paris, France
- Institut Pasteur, INSERM U1117, Paris, France
- Département de maladies infectieuses et tropicales, AP-HP, Hôpital Universitaire Necker, Paris, France
| | - Victoire De Lastours
- Université de Paris, Faculté de Médecine, Paris, France
- IAME, UMR1137, INSERM, Paris, France
- Service de Médecine Interne, AP-HP, Hôpital Beaujon, Clichy, France
| | - Albert Faye
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Pédiatrie Générale, Hôpital Robert Debré, Paris, INSERM ECEVE 1123, Paris, France
| | - Eve Jablon
- Service AGIR, Université de Paris, Faculté de Médecine, Paris, France
| | - Natacha Kadlub
- Université de Paris, Faculté de Médecine, Paris, France
- Département de chirurgie maxillo-faciale et de chirurgie plastique, AP-HP, Hôpital Universitaire Necker, Paris, France
| | - Julien Leguen
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Gériatrie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - David Lebeaux
- Université de Paris, Faculté de Médecine, Paris, France
- Département de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Alexandre Malmartel
- Département de médecine générale, Université de Paris, Faculté de Médecine, Paris, France
| | - Tristan Mirault
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Département d’hypertension artérielle, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Benjamin Planquette
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM UMR S1140, Paris, France
- Service de Pneumologie et de soins intensifs, AH-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Alexis Régent
- Université de Paris, Faculté de Médecine, Paris, France
- Institut Cochin, INSERM U1016, CNRS UMR 8104, LabEx INFLAMEX, Paris, France
- Service de Médecine Interne, Centre de Référence pour les Maladies Systémiques Auto immunes Rares d’Ile-de-France, AP-HP, Hôpital Cochin, Paris, France
| | - Jean-Laurent Thebault
- Département de médecine générale, Université de Paris, Faculté de Médecine, Paris, France
| | - Alexy Tran Dinh
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM U1148 LVTS, Villetanneuse, France
- Département d'Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Alexandre Nuzzo
- Université de Paris, Faculté de Médecine, Paris, France
- Service de gastro-entérologie et pancréatologie, AP-HP, Hôpital Beaujon, Paris, France
| | - Guillaume Turc
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM U1266, Paris, France
- Service de neurologie, Hôpital Sainte Anne, AH-HP, Paris, France
| | - Gérard Friedlander
- Université de Paris, Faculté de Médecine, Paris, France
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151-CNRS UMR8253, Paris, France
| | - Philippe Ruszniewski
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM U1266, Paris, France
- INSERM UMR1149, Paris, France
| | - Cécile Badoual
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Service d’anatomopathologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Brigitte Ranque
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Service de Médecine interne, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Mehdi Oualha
- Université de Paris, Faculté de Médecine, Paris, France
- Unité EA7323, Université de Paris, Faculté de Médecine, Paris, France
- Service de réanimation et de surveillance continue médico-chirurgicale pédiatrique, AP-HP, Hôpital Universitaire Necker, Paris, France
| | - Marie Courbebaisse
- Université de Paris, Faculté de Médecine, Paris, France
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151-CNRS UMR8253, Paris, France
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Le Roux E, Mari Muro M, Mognon K, Saïd M, Caillavet V, Matheron S, Ledoux S, Decq P, Vorspan F, Le Strat Y, Delaugerre C, Le Bras M, Alberti C, Ruszniewski P, Zerr P, Faye A. A governmental program to encourage medical students to deliver primary prevention: experiment and evaluation in a French faculty of medicine. BMC Med Educ 2021; 21:47. [PMID: 33435980 PMCID: PMC7805043 DOI: 10.1186/s12909-020-02472-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/22/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND A public health student service was set up by the French government in 2018 with the aim of increasing awareness of primary health promotion among the 47,000 students of medicine and other health professions. It is an annual program involving community-based actions on nutrition, physical activity, addiction or sexuality. Our objective was to evaluate its implementation at local level and the different experiences of the stakeholders. METHODS A quasi-experimental study using process evaluation was performed in a Faculty of Medicine in Paris. Quantitative and qualitative data were collected from medical students who carried out preventive health actions, in the institutions in which the actions took place and from a subsample of beneficiaries. RESULTS One hundred and eight actions were carried out by 341 students in 23 educational or social institutions, mostly high schools (n = 12, 52%). Two thirds of the students did not feel sufficiently prepared to deliver preventive health interventions (65.7%, 224/341); however the beneficiaries found that the interventions were good (278/280, 99,2%). Nineteen (83%) of the host institutions agreed to welcome health service students again, of which 9 required some modifications. For students, the reporting of a satisfactory health service experience was associated with the reporting of skills or knowledge acquisition (p < 0.01). Delivering actions in high schools and to a medium-sized number of beneficiaries per week was associated with students' satisfaction. No effect of gender or theme of prevention was observed. For 248/341 (72.7%) students, the public health service program prompts them to address prevention issues in the future. CONCLUSION The public health service undertaken by medical students through the program is a feasible and acceptable means of delivering preventive actions. Reinforcement of training and closer interaction with the host institutions would improve results.
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Affiliation(s)
- Enora Le Roux
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010, Paris, France.
- Service de Santé Publique, AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, 48 boulevard Serurier, CIC 1426, F-75019, Paris, France.
| | - Marta Mari Muro
- Service de Santé Publique, AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, 48 boulevard Serurier, CIC 1426, F-75019, Paris, France
| | - Kore Mognon
- General Medecine department, Université de Paris, F-75018, Paris, France
| | - Mélèa Saïd
- Service de Santé Publique, AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, 48 boulevard Serurier, CIC 1426, F-75019, Paris, France
| | | | - Sophie Matheron
- Unité UMR 1137 IAME, Université de Paris, Inserm, F-75010, Paris, France
- AP-HP, Nord-Université de Paris, Hôpital Universitaire Bichat-Claude Bernard, Service de maladies infectieuses et tropicale, F-75018, Paris, France
| | - Séverine Ledoux
- AP-HP, Nord-Université de Paris, Hôpital Louis Mourier, Service des explorations fonctionnelles, F-92700, Colombes, France
| | - Philippe Decq
- AP-HP, Nord-Université de Paris, Hôpital Beaujon, Service de neurochirurgie, F-92110, Clichy, France
| | - Florence Vorspan
- AP-HP, Nord-Université de Paris, Hôpital Lariboisière, Service de psychiatrie, F-75010, Paris, France
| | - Yann Le Strat
- AP-HP, Nord-Université de Paris, Hôpital Louis Mourier, Service de psychiatrie, F-92700, Colombes, France
- INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), F-75014, Paris, France
| | - Constance Delaugerre
- AP-HP, Nord-Université de Paris, Hôpital Saint Louis, Service de virologie, INSERM U944, F-75010, Paris, France
| | - Morgane Le Bras
- Université de Paris, UMR_S 976, Inserm, Institut de Recherche Saint Louis, F-75010, Paris, France
| | - Corinne Alberti
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010, Paris, France
- Service de Santé Publique, AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, 48 boulevard Serurier, CIC 1426, F-75019, Paris, France
| | | | - Philippe Zerr
- General Medecine department, Université de Paris, F-75018, Paris, France
| | - Albert Faye
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010, Paris, France
- Service de Pédiatrie Générale, AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, F-75019, Paris, France
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Dokmak S, Tetart A, Aussilhou B, Choquet A, Rebours V, Vullierme MP, Soubrane O, Ruszniewski P, Lévy P, Sauvanet A. French reconnection: A conservative pancreato-enteric reconnection for disconnected pancreatic duct syndrome. Pancreatology 2021; 21:282-290. [PMID: 33168404 DOI: 10.1016/j.pan.2020.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/03/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Disconnectedpancreatic duct syndrome (DPDS), a severe complication of acute necrotizing pancreatitis (ANP), may require surgery, usually by distal splenopancreatectomy, thus increasing the risk of diabetes. We describe a new technique reconnecting the distal pancreas to the digestive tract. METHODS This technique was proposed after failure of non-surgical treatment and at least 3 months after the onset of ANP in non-diabetic or non-insulin dependent diabetic patients with a distal pancreas of at least 5 cm. The ruptured zone was identified and the distal side was anastomosed to the stomach or the jejunum. RESULTS From 2013 to June 2019, 36 patients (median age = 49 years) with DPDS underwent a "French reconnection" procedure, indicated for chronic pain/recurrent pancreatitis (n = 35; 97%), persistent pancreatic fistula (n = 33; 91%), or digestive compression/fistulisation (n = 9; 25%). Median preoperative weight loss was 10 kg (4-27), the median number of hospitalisations per patient was 5(1-8) and 24(67%) patients had received endoscopic/percutaneous treatment. Surgery was performed in median 279(90-2000) days after ANP, laparoscopically in 9(25%) patients. The remnant pancreas (median length = 70 mm; range = 50-130) was anastomosed to the stomach (n = 30) or the jejunum (n = 6). There were 13(36%) postoperative grade B/C pancreatic fistulas and 3(10%) bleedings including one death (mortality = 3%). The median hospital stay was 18 (7-121) days. After a median follow-up of 24 (4-53) months, all pancreatic fistulas had healed and the clinical success rate was 91%. Median BMI increased from 22 to 25 kg/m2. In patients with normal pancreatic function, postoperative de novo endocrine and severe exocrine insufficiencies were observed in 4/27 (15%) and 7/22 (32%), respectively. CONCLUSIONS The "French reconnection" procedure, as an alternative to distal splenopancreatectomy for the treatment of DPDS, provides good control of symptoms and decreases the risk of pancreatic insufficiency.
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Affiliation(s)
- Safi Dokmak
- Department of HPB Surgery, Assistance Publique Hôpitaux de Paris - University of Paris, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France.
| | - Auriana Tetart
- Department of HPB Surgery, Assistance Publique Hôpitaux de Paris - University of Paris, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Béatrice Aussilhou
- Department of HPB Surgery, Assistance Publique Hôpitaux de Paris - University of Paris, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Anaïs Choquet
- Department of HPB Surgery, Assistance Publique Hôpitaux de Paris - University of Paris, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Vinciane Rebours
- Department of Gastroenterology and Pancreatic Diseases, Assistance Publique Hôpitaux de Paris - University of Paris, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Marie Pierre Vullierme
- Department of Radiology, Assistance Publique Hôpitaux de Paris - University of Paris, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Olivier Soubrane
- Department of HPB Surgery, Assistance Publique Hôpitaux de Paris - University of Paris, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatic Diseases, Assistance Publique Hôpitaux de Paris - University of Paris, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Philippe Lévy
- Department of Gastroenterology and Pancreatic Diseases, Assistance Publique Hôpitaux de Paris - University of Paris, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Alain Sauvanet
- Department of HPB Surgery, Assistance Publique Hôpitaux de Paris - University of Paris, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France
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Tannoury J, de Mestier L, Hentic O, Ruszniewski P, Créange A, Sobhani I. Contribution of Immune-Mediated Paraneoplastic Syndromes to Neurological Manifestations of Neuroendocrine Tumours: A Retrospective Study. Neuroendocrinology 2021; 111:123-128. [PMID: 32040952 DOI: 10.1159/000506400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 02/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neurological symptoms associated with neuroendocrine tumours (NETs) may be related to metastatic disease or paraneoplastic syndromes (PNSs); these last are often associated with autoantibodies targeting various onconeural antigens. To better characterize neurological PNSs related to NETs, we report the largest case-series study to date. METHODS We retrospectively reviewed the charts of all patients diagnosed with NETs of the gastrointestinal tract who presented with neurological symptoms at either of 2 tertiary academic hospitals (Henri Mondor and Beaujon, France) between 1994 and 2016. All patients underwent extensive neurological tests including clinical, laboratory, and radiological investigations. The clinical response to immunomodulating agents was recorded. RESULTS In the 13 identified patients, the most common presentations were peripheral neuropathy (46.2%) and encephalopathy (26.6%). Of the 6 (53.3%) patients whose serum anti-neuronal antibodies were assayed, 5 had high titres. Short-term oral corticosteroid and immunosuppressant drug therapy was given to 4 of these patients, of whom 3 had a clinical response and 1 no response. Repeated high-dose intravenous immunoglobulin therapy induced a complete clinical response in 1 patient. Encephalopathy resolved fully after hepatectomy or intrahepatic chemoembolization for liver metastases in another 2 patients. DISCUSSION The neurological symptoms associated with NETs may be due in part to autoimmune PNS. Based on experience at our 2 centres, we estimate that autoimmune PNS occurs in about 1% of patients with NETs. Early symptom recognition allows the initiation of effective treatments including corticosteroids, immunosuppressive drugs, and/or intravenous immunoglobulins.
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Affiliation(s)
- Jenny Tannoury
- Department of Gastroenterology, Henri Mondor University Hospital, Creteil, France
- EC2M3-EA7375 Paris Est Creteil University (UPEC), Creteil, France
| | - Louis de Mestier
- Department of Gastroenterology-Pancreatology, Beaujon University Hospital, Paris Diderot University, ENETS Centre of Excellence, Clichy, France
| | - Olivia Hentic
- Department of Gastroenterology-Pancreatology, Beaujon University Hospital, Paris Diderot University, ENETS Centre of Excellence, Clichy, France
| | - Philippe Ruszniewski
- Department of Gastroenterology-Pancreatology, Beaujon University Hospital, Paris Diderot University, ENETS Centre of Excellence, Clichy, France
| | - Alain Créange
- Department of Neurology, Henri Mondor University Hospital, Paris Est Creteil University (UPEC), Creteil, France
| | - Iradj Sobhani
- Department of Gastroenterology, Henri Mondor University Hospital, Creteil, France,
- EC2M3-EA7375 Paris Est Creteil University (UPEC), Creteil, France,
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Cros J, Théou-Anton N, Gounant V, Nicolle R, Reyes C, Humez S, Hescot S, Thomas de Montpréville V, Guyétant S, Scoazec JY, Guyard A, de Mestier L, Brosseau S, Mordant P, Castier Y, Gentien D, Ruszniewski P, Zalcman G, Couvelard A, Cazes A. Specific Genomic Alterations in High-Grade Pulmonary Neuroendocrine Tumours with Carcinoid Morphology. Neuroendocrinology 2021; 111:158-169. [PMID: 32015233 DOI: 10.1159/000506292] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 01/30/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION High-grade lung neuroendocrine tumours with carcinoid morphology have been recently reported; they may represent the thoracic counterparts of grade 3 digestive neuroendocrine tumours. We aimed to study their genetic landscape including analysis of tumoral heterogeneity. METHODS Eleven patients with high-grade (>20% Ki-67 and/or >10 mitoses) lung neuroendocrine tumours with a carcinoid morphology were included. We analysed copy number variations, somatic mutations, and protein expression in 16 tumour samples (2 samples were available for 5 patients allowing us to study spatial and temporal heterogeneity). RESULTS Genomic patterns were heterogeneous ranging from "quiet" to tetraploid, heavily rearranged genomes. Oncogene mutations were rare and most genetic alterations targeted tumour suppressor genes. Chromosomes 11 (7/11), 3 (6/11), 13 (4/11), and 6-17 (3/11) were the most frequently lost. Altered tumour suppressor genes were common to both carcinoids and neuroendocrine carcinomas, involving different pathways including chromatin remodelling (KMT2A, ARID1A, SETD2, SMARCA2, BAP1, PBRM1, KAT6A), DNA repair (MEN1, POLQ, ATR, MLH1, ATM), cell cycle (RB1, TP53, CDKN2A), cell adhesion (LATS2, CTNNB1, GSK3B) and metabolism (VHL). Comparative spatial/temporal analyses confirmed that these tumours emerged from clones of lower aggressivity but revealed that they were genetically heterogeneous accumulating "neuroendocrine carcinoma-like" genetic alterations through progression such as TP53/RB1 alterations. CONCLUSION These data confirm the importance of chromatin remodelling genes in pulmonary carcinoids and highlight the potential role of TP53 and RB1 to drive the transformation in more aggressive high-grade tumours.
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Affiliation(s)
- Jerôme Cros
- Department of Pathology, ENETS Centre of Excellence, Beaujon-Bichat Hospitals, AP-HP, Paris, France
- Université de Paris, Paris, France
- INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France
| | | | - Valérie Gounant
- Department of Thoracic Oncology and Early Phase Clinical Trials Unit (CIC1425/CLIP2), Bichat Hospital, AP-HP, Paris, France
| | - Remy Nicolle
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre le Cancer, Paris, France
| | - Cécile Reyes
- Institut Curie, PSL Research University, Translational Research Department, Genomics Platform, Paris, France
| | - Sarah Humez
- Department of Pathology, CHRU de Lille, Lille, France
| | - Ségolène Hescot
- Department of Nuclear Medicine, Institut Curie, CLCC, Saint-Cloud, France
| | | | | | - Jean-Yves Scoazec
- Department of Biopathology, Gustave Roussy Cancer Campus, Villejuif, France
- Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Alice Guyard
- Department of Pathology, ENETS Centre of Excellence, Beaujon-Bichat Hospitals, AP-HP, Paris, France
| | - Louis de Mestier
- Université de Paris, Paris, France
- INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France
| | - Solenn Brosseau
- Université de Paris, Paris, France
- Department of Thoracic Oncology and Early Phase Clinical Trials Unit (CIC1425/CLIP2), Bichat Hospital, AP-HP, Paris, France
| | - Pierre Mordant
- Université de Paris, Paris, France
- Department of Vascular and Thoracic Surgery, Bichat University Hospital, AP-HP, Université de Paris, Paris, France
| | - Yves Castier
- Université de Paris, Paris, France
- Department of Vascular and Thoracic Surgery, Bichat University Hospital, AP-HP, Université de Paris, Paris, France
| | - David Gentien
- Institut Curie, PSL Research University, Translational Research Department, Genomics Platform, Paris, France
| | - Philippe Ruszniewski
- Université de Paris, Paris, France
- INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France
| | - Gérard Zalcman
- Université de Paris, Paris, France
- Department of Thoracic Oncology and Early Phase Clinical Trials Unit (CIC1425/CLIP2), Bichat Hospital, AP-HP, Paris, France
| | - Anne Couvelard
- Department of Pathology, ENETS Centre of Excellence, Beaujon-Bichat Hospitals, AP-HP, Paris, France,
- Université de Paris, Paris, France,
- INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France,
| | - Aurélie Cazes
- Department of Pathology, ENETS Centre of Excellence, Beaujon-Bichat Hospitals, AP-HP, Paris, France
- Université de Paris, Paris, France
- INSERM U1152, Paris, France
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Guarneri G, de Mestier L, Landoni L, Partelli S, Gaujoux S, Andreasi V, Nessi C, Dokmak S, Fontana M, Dousset B, Ruszniewski P, Bassi C, Falconi M, Sauvanet A. Prognostic Role of Examined and Positive Lymph Nodes after Distal Pancreatectomy for Non-Functioning Neuroendocrine Neoplasms. Neuroendocrinology 2021; 111:728-738. [PMID: 32585667 DOI: 10.1159/000509709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The most appropriate nodal staging system for non-functioning pancreatic neuroendocrine tumours (NF-PanNETs) remains unclear. Despite some evidence is available for pancreaticoduodenectomy, the adequate nodal staging is still unknown for distal pancreatectomy (DP). The aim of the present study was to evaluate the prognostic impact of the number of positive lymph nodes (PLNs) after DP for NF-PanNETs and to define the minimal number of lymph nodes to be harvested for an appropriate nodal staging. METHODS Data were retrospectively collected from patients who underwent DP with curative intent (R0-R1) for sporadic well-differentiated NF-PanNETs in 4 European high-volume centres. NF-PanNETs with nodal involvement (N+) were subclassified into N1 (1-3 PLNs) and N2 (4 or more PLNs). Univariate and multivariate analyses of disease-free survival (DFS) were performed. RESULTS Of 271 patients in the study, 62 (23%) had nodal involvement (N+). A higher probability of N+ was associated with the following factors: grading, resection margin status, perineural and microvascular invasion, and the number of examined lymph nodes. Three-year DFS rate for N0, N1, and N2 patients was 92, 72, and 50%, respectively (p < 0.001). At multivariate analysis, independent predictors of DFS were grading, T stage, presence of necrosis, and nodal status. For patients with ≥12 examined/resected lymph nodes, the N status remained a significant predictor of disease recurrence (p < 0.001), while it failed to predict recurrence in patients with <12 lymph nodes examined/resected (p = 0.116). CONCLUSIONS A minimal number of 12 nodes should be harvested in case of DP for NF-PanNET for an appropriate nodal staging. The number of positive lymph nodes is an independent predictor of DFS after DP for NF-PanNET, and the N0/N1/N2 nodal classification seems to be more relevant than the current N0/N+ staging.
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Affiliation(s)
- Giovanni Guarneri
- Department of Hepato-Bilio-Pancreatic Surgery, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France,
- Pancreatic Surgery Unit, ENETS Centre of Excellence, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy,
| | - Louis de Mestier
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France
| | - Luca Landoni
- General and Pancreatic Surgery, Pancreas Institute, University of Verona, Verona, Italy
| | - Stefano Partelli
- Pancreatic Surgery Unit, ENETS Centre of Excellence, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Sébastien Gaujoux
- Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Paris, France
| | - Valentina Andreasi
- Pancreatic Surgery Unit, ENETS Centre of Excellence, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Nessi
- General and Pancreatic Surgery, Pancreas Institute, University of Verona, Verona, Italy
| | - Safi Dokmak
- Department of Hepato-Bilio-Pancreatic Surgery, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France
| | - Michele Fontana
- General and Pancreatic Surgery, Pancreas Institute, University of Verona, Verona, Italy
| | - Bertrand Dousset
- Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Paris, France
| | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France
| | - Claudio Bassi
- General and Pancreatic Surgery, Pancreas Institute, University of Verona, Verona, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, ENETS Centre of Excellence, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alain Sauvanet
- Department of Hepato-Bilio-Pancreatic Surgery, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France
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Yao JC, Strosberg J, Fazio N, Pavel ME, Bergsland E, Ruszniewski P, Halperin DM, Li D, Tafuto S, Raj N, Campana D, Hijioka S, Raderer M, Guimbaud R, Gajate P, Pusceddu S, Reising A, Degtyarev E, Shilkrut M, Eddy S, Singh S. Spartalizumab in metastatic, well/poorly-differentiated neuroendocrine neoplasms. Endocr Relat Cancer 2021; 28:ERC-20-0382.R1. [PMID: 33480358 DOI: 10.1530/erc-20-0382] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
Spartalizumab, a humanized anti-programmed death protein 1 (PD-1) monoclonal antibody, was evaluated in patients with well-differentiated metastatic grade 1/2 neuroendocrine tumors (NET) and poorly-differentiated gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC). In this phase II, multicenter, single-arm study, patients received spartalizumab 400 mg every 4 weeks until confirmed disease progression or unacceptable toxicity. The primary endpoint was confirmed overall response rate (ORR) according to blinded independent review committee using response evaluation criteria in solid tumors 1.1. The study enrolled 95 patients in the NET group (30, 32 and 33 in the thoracic, gastrointestinal, and pancreatic cohorts, respectively), and 21 patients in the GEP-NEC group. The ORR was 7.4% (95% confidence interval [CI]: 3.0, 14.6) in the NET group (thoracic, 16.7%; gastrointestinal, 3.1%; pancreatic, 3.0%), which was below the predefined success criterion of ≥10%, and 4.8% (95% CI: 0.1, 23.8) in the GEP-NEC group. In the NET and GEP-NEC groups, the 12-month progression-free survival was 19.5% and 0%, respectively, and the 12-month overall survival was 73.5% and 19.1%, respectively. The ORR was higher in patients with ≥1% PD-L1 expression in immune/tumor cells or ≥1% CD8+ cells at baseline. The most common adverse events considered as spartalizumab-related included fatigue (29.5%) and nausea (10.5%) in the NET group, and increased aspartate and alanine aminotransferases (each 14.3%) in the GEP-NEC group. The efficacy of spartalizumab was limited in this heterogeneous and heavily pre-treated population; however, the results in the thoracic cohort is encouraging and warrants further investigation. Adverse events were manageable and consistent with previous experience.
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Affiliation(s)
- James C Yao
- J Yao, Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | | | - Nicola Fazio
- N Fazio, Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, Istituto Europeo di Oncologia, Milano, Italy
| | - Marianne E Pavel
- M Pavel, Department of Medicine 1, Division of Endocrinology and Diabetology, Friedrich-Alexander Universität Erlangen-Nürnberg, Friedrich Alexander University Erlangen Nuremberg Faculty of Medicine, Erlangen, Germany
| | - Emily Bergsland
- E Bergsland, Department of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, United States
| | - Philippe Ruszniewski
- P Ruszniewski, Gastroenterology and Pancreatology, Hopital Beaujon, Clichy, France
| | - Daniel M Halperin
- D Halperin, Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Daneng Li
- D Li, Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, United States
| | - Salvatore Tafuto
- S Tafuto, Medicine, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Nitya Raj
- N Raj, Medicine, Memorial Sloan-Kettering Cancer Center, New York, 10065, United States
| | - Davide Campana
- D Campana, Internal Medicine and Gastroenterology, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Susumu Hijioka
- S Hijioka, Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Japan, Chuo-ku, Japan
| | - Markus Raderer
- M Raderer, Oncology, Medical University of Vienna Department of Internal Medicine, Wien, Vanuatu
| | - Rosine Guimbaud
- R Guimbaud, Oncology, CHU Toulouse Département de Médecine Nucléaire, Toulouse, France
| | - Pablo Gajate
- P Gajate, Medical Oncology, Hospital Universitario Ramon y Cajal, Madrid, 28015, Spain
| | - Sara Pusceddu
- S Pusceddu, Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Albert Reising
- A Reising, Oncology, Novartis Pharmaceuticals Corp, East Hanover, United States
| | - Evgeny Degtyarev
- E Degtyarev, Oncology, Novartis Pharmaceuticals Corp, East Hanover, United States
| | - Mark Shilkrut
- M Shilkrut, Oncology, Novartis Pharmaceuticals Corp, East Hanover, United States
| | - Simantini Eddy
- S Eddy, Oncology, Novartis Pharmaceuticals Corp, East Hanover, United States
| | - Simron Singh
- S Singh, Medical Oncologist, Sunnybrook Health Sciences Centre, Toronto, Canada
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40
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Gay-Chevallier S, de Mestier L, Perinel J, Forestier J, Hervieu V, Ruszniewski P, Millot I, Valette PJ, Pioche M, Lombard-Bohas C, Subtil F, Adham M, Walter T. Management and Prognosis of Localized Duodenal Neuroendocrine Neoplasms. Neuroendocrinology 2021; 111:718-727. [PMID: 32335556 DOI: 10.1159/000508102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/21/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The characteristics, prognostic factors, and management of duodenal neuroendocrine neoplasms (dNEN) are ill-defined, given their rarity. Whether nonsurgical management might be appropriate for patients with nonmetastatic dNEN and a good prognosis, as is the case for pancreatic NEN (pNEN), is unknown. We aimed to describe the management and prognosis of nonmetastatic dNEN patients. METHODS All consecutive patients with nonmetastatic dNEN managed between 1981 and 2018 in 2 expert centers were included. Recurrence-free survival (RFS) and factors associated with recurrence were estimated. RESULTS A total of 145 patients with dNEN were included. Twenty-eight patients with sporadic, nonfunctioning, small (median 7 mm) dNEN underwent endoscopic resection, with a 5-year RFS rate of 89.4%. Local recurrence occurred in 2 patients, who underwent surgery with no new events. The 5-year RFS rate was 87.9% in patients who underwent surgery. Upon univariate analysis, age, size, Ki67 index, and lymph node involvement (LN+) were significantly associated with worse RFS for all dNEN treated (endoscopy/surgery); multivariate analysis found that age, size, and LN+ were associated with worse RFS. CONCLUSION Selected nonmetastatic dNEN had a favorable outcome, and a less invasive therapeutic strategy appeared more suitable than oncological surgery.
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Affiliation(s)
- Servane Gay-Chevallier
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France
| | - Louis de Mestier
- Service de Gastroentérologie et Pancréatologie, Hôpital Beaujon, Université de Paris, Clichy, France
| | - Julie Perinel
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Julien Forestier
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France
| | - Valérie Hervieu
- Université Lyon 1, Université de Lyon, Lyon, France
- Hospices Civils de Lyon, Service de Pathologie Multisite, Site EST, Centre de Biologie et de Pathologie Est, Bron, France
| | - Philippe Ruszniewski
- Service de Gastroentérologie et Pancréatologie, Hôpital Beaujon, Université de Paris, Clichy, France
| | - Ingrid Millot
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d'anesthésie-Réanimation, Lyon, France
| | - Pierre-Jean Valette
- Université Lyon 1, Université de Lyon, Lyon, France
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Radiologie, Lyon, France
| | - Mathieu Pioche
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Catherine Lombard-Bohas
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France
| | - Fabien Subtil
- Université Lyon 1, Université de Lyon, Lyon, France
- Hospices Civils de Lyon, Service de Biostatistiques, Lyon, France
- CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Mustapha Adham
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Thomas Walter
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France,
- Université Lyon 1, Université de Lyon, Lyon, France,
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De Rycke O, Védie AL, Guarneri G, Nin F, De Flori C, Hentic O, Idri S, Sauvanet A, Rebours V, Cros J, Couvelard A, Ruszniewski P, de Mestier L. O-positive blood type is associated with prolonged recurrence-free survival following curative resection of pancreatic neuroendocrine tumors. Pancreatology 2020; 20:1718-1722. [PMID: 33032924 DOI: 10.1016/j.pan.2020.09.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The ABO blood group may influence the development and progression of cancer. In particular, the prognosis of patients with blood type O is better for pancreatic adenocarcinoma, although this has not been extensively explored in pancreatic neuroendocrine tumors (PanNET). OBJECTIVE To assess the influence of the ABO and Rhesus blood types on the risk of recurrence in patients who underwent curative intent PanNET surgical resection. METHODS All consecutive patients operated on for well-differentiated panNET in an expert center from 2003 to 2018 were retrospectively included. Blood group, Rhesus system, demographic and clinical data were collected. The primary endpoint was recurrence free survival (RFS). Factors associated with RFS were explored using Cox proportional hazard models. RESULTS Overall, 300 patients (male 43%) were included, median age 54 years old (IQR 45-64). The ABO blood group distribution was similar to that of the French population. There was no association between blood group and tumor features. The median postoperative follow-up was 43.9 months (17.0-77.8). The 5- and 10-year RFS rates were 85 ± 4% and 71 ± 13% in O RhD + patients, versus 72 ± 4% and 63 ± 6% otherwise, respectively (p = 0.035). The O RhD + blood group was associated with a decreased risk of recurrence (HR 0.34, 95% CI [0.15-0.75]), p = 0.007 in multivariable analysis adjusted for age, ki67, functioning syndrome, resection margins, tumor size, lymph node status, oncogenetic syndrome. CONCLUSIONS After curative-intent surgical resection for PanNET, patients with a non-O RhD + blood group may have an increased risk of recurrence and could benefit from closer follow-up.
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Affiliation(s)
- Ophélie De Rycke
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), Clichy, France; Université de Paris, France; INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France
| | - Anne-Laure Védie
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), Clichy, France; Université de Paris, France
| | - Giovanni Guarneri
- Department of Hepato-Bilio-Pancreatic Surgery, ENETS Centre of Excellence, Beaujon University Hospital (APHP), Clichy, France
| | - Frédéric Nin
- Établissement Français du Sang Ile de France, Beaujon University Hospital (APHP), Clichy, France
| | - Céline De Flori
- INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France
| | - Olivia Hentic
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), Clichy, France
| | - Salim Idri
- Établissement Français du Sang Ile de France, Beaujon University Hospital (APHP), Clichy, France
| | - Alain Sauvanet
- Université de Paris, France; INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France; Department of Hepato-Bilio-Pancreatic Surgery, ENETS Centre of Excellence, Beaujon University Hospital (APHP), Clichy, France
| | - Vinciane Rebours
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), Clichy, France; Université de Paris, France; INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France
| | - Jérôme Cros
- Université de Paris, France; INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France; Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon University Hospital (APHP), Paris/Clichy, France
| | - Anne Couvelard
- Université de Paris, France; INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France; Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon University Hospital (APHP), Paris/Clichy, France
| | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), Clichy, France; Université de Paris, France; INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France
| | - Louis de Mestier
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), Clichy, France; Université de Paris, France; INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France.
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de Mestier L, Couvelard A, Blazevic A, Hentic O, de Herder WW, Rebours V, Paradis V, Ruszniewski P, Hofland LJ, Cros J. Critical appraisal of MGMT in digestive NET treated with alkylating agents. Endocr Relat Cancer 2020; 27:R391-R405. [PMID: 32698158 DOI: 10.1530/erc-20-0227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 11/08/2022]
Abstract
The efficacy of alkylating agents (temozolomide, dacarbazine, streptozotocin) in patients with advanced neuroendocrine tumors (NETs) has been well documented, especially in pancreatic NETs. Alkylating agents transfer methyl adducts on DNA bases. Among them, O6-methylguanine accounts for many of their cytotoxic effects and can be repaired by the O6-methylguanine-methyltransferase (MGMT). However, whether the tumor MGMT status could be a reliable biomarker of efficacy of alkylating agents in NETs is still a matter of debate. Herein, we sought to provide a critical appraisal of the role of the MGMT status in NETs. After reviewing the molecular mechanisms of repair of DNA damage induced by alkylating agents, we aimed to comprehensively review the methods of determination of the MGMT status and its impact on prognosis, prediction of objective response and progression-free survival in patients with advanced digestive NETs treated by alkylating agents. About half of pancreatic NETs are MGMT-deficient, as determined by impaired tumor MGMT expression or by MGMT promoter methylation. Overall, while published studies are heterogeneous and mostly limited in size, they advocate that MGMT deficiency may be a relevant biomarker for increased objective response rate, prolonged progression-fee survival and overall survival in patients with advanced NETs treated by alkylating agents. While these data require confirmation in prospective controlled studies, future research should focus on the standardization of MGMT status assessment. Additional mechanisms of repair of DNA damages induced by alkylating agents should be explored in order to identify biomarkers complementary to MGMT and targets for potential antitumor synergy, such as PARP.
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Affiliation(s)
- Louis de Mestier
- Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), and Université de Paris, Clichy, France
- Centre of Research on Inflammation, INSERM U1149, Paris, France
| | - Anne Couvelard
- Centre of Research on Inflammation, INSERM U1149, Paris, France
- Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon University Hospitals (APHP), and Université de Paris, Clichy/Paris, France
| | - Anela Blazevic
- Division Endocrinology, Department of Internal Medicine, ENETS Centre of Excellence, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Olivia Hentic
- Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), and Université de Paris, Clichy, France
| | - Wouter W de Herder
- Division Endocrinology, Department of Internal Medicine, ENETS Centre of Excellence, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vinciane Rebours
- Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), and Université de Paris, Clichy, France
- Centre of Research on Inflammation, INSERM U1149, Paris, France
| | - Valérie Paradis
- Centre of Research on Inflammation, INSERM U1149, Paris, France
- Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon University Hospitals (APHP), and Université de Paris, Clichy/Paris, France
| | - Philippe Ruszniewski
- Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), and Université de Paris, Clichy, France
- Centre of Research on Inflammation, INSERM U1149, Paris, France
| | - Leo J Hofland
- Division Endocrinology, Department of Internal Medicine, ENETS Centre of Excellence, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jérôme Cros
- Centre of Research on Inflammation, INSERM U1149, Paris, France
- Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon University Hospitals (APHP), and Université de Paris, Clichy/Paris, France
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Azoulay A, Cros J, Vullierme MP, de Mestier L, Couvelard A, Hentic O, Ruszniewski P, Sauvanet A, Vilgrain V, Ronot M. Morphological imaging and CT histogram analysis to differentiate pancreatic neuroendocrine tumor grade 3 from neuroendocrine carcinoma. Diagn Interv Imaging 2020; 101:821-830. [PMID: 32709455 DOI: 10.1016/j.diii.2020.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare morphological imaging features and CT texture histogram parameters between grade 3 pancreatic neuroendocrine tumors (G3-NET) and neuroendocrine carcinomas (NEC). MATERIALS AND METHODS Patients with pathologically proven G3-NET and NEC, according to the 2017 World Health Organization classification who had CT and MRI examinations between 2006-2017 were retrospectively included. CT and MRI examinations were reviewed by two radiologists in consensus and analyzed with respect to tumor size, enhancement patterns, hemorrhagic content, liver metastases and lymphadenopathies. Texture histogram analysis of tumors was performed on arterial and portal phase CT images. images. Morphological imaging features and CT texture histogram parameters of G3-NETs and NECs were compared. RESULTS Thirty-seven patients (21 men, 16 women; mean age, 56±13 [SD] years [range: 28-82 years]) with 37 tumors (mean diameter, 60±46 [SD] mm) were included (CT available for all, MRI for 16/37, 43%). Twenty-three patients (23/37; 62%) had NEC and 14 patients (14/37; 38%) had G3-NET. NECs were larger than G3-NETs (mean, 70±51 [SD] mm [range: 18 - 196mm] vs. 42±24 [SD] mm [range: 8 - 94mm], respectively; P=0.039), with more tumor necrosis (75% vs. 33%, respectively; P=0.030) and lower attenuation on precontrast (30±4 [SD] HU [range: 25-39 HU] vs. 37±6 [SD] [range: 25-45 HU], respectively; P=0.002) and on portal venous phase CT images (75±18 [SD] HU [range: 43 - 108 HU] vs. 92±19 [SD] HU [range: 46 - 117 HU], respectively; P=0.014). Hemorrhagic content on MRI was only observed in NEC (P=0.007). The mean ADC value was lower in NEC ([1.1±0.1 (SD)]×10-3 mm2/s [range: (0.91 - 1.3)×10-3 mm2/s] vs. [1.4±0.2 (SD)]×10-3 mm2/s [range: (1.1 - 1.6)×10-3 mm2/s]; P=0.005). CT histogram analysis showed that NEC were more heterogeneous on portal venous phase images (Entropy-0: 4.7±0.2 [SD] [range: 4.2-5.1] vs. 4.5±0.4 [SD] [range: 3.7-4.9]; P=0.023). CONCLUSION Pancreatic NECs are larger, more frequently hypoattenuating and more heterogeneous with hemorrhagic content than G3-NET on CT and MRI.
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Affiliation(s)
- A Azoulay
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France
| | - J Cros
- Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; Université de Paris, Diderot Paris 7, 75010 Paris, France; INSERM U1149, CRI, Paris, France
| | - M-P Vullierme
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France
| | - L de Mestier
- Université de Paris, Diderot Paris 7, 75010 Paris, France; Department of Pancreatology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; INSERM U1149, CRI, Paris, France
| | - A Couvelard
- Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; Université de Paris, Diderot Paris 7, 75010 Paris, France; INSERM U1149, CRI, Paris, France
| | - O Hentic
- Department of Pancreatology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France
| | - P Ruszniewski
- Université de Paris, Diderot Paris 7, 75010 Paris, France; Department of Pancreatology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; INSERM U1149, CRI, Paris, France
| | - A Sauvanet
- Department of HPB Surgery, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France
| | - V Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; Université de Paris, Diderot Paris 7, 75010 Paris, France; INSERM U1149, CRI, Paris, France
| | - M Ronot
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; Université de Paris, Diderot Paris 7, 75010 Paris, France; INSERM U1149, CRI, Paris, France.
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Lotfalizadeh E, Ronot M, Wagner M, Cros J, Couvelard A, Vullierme MP, Allaham W, Hentic O, Ruszniewski P, Vilgrain V. Correction to: Prediction of pancreatic neuroendocrine tumour grade with MR imaging features: added value of diffusion-weighted imaging. Eur Radiol 2020; 30:6387. [PMID: 32500190 DOI: 10.1007/s00330-020-06947-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The original version of this article, published on 19 August 2016, unfortunately contained a mistake.
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Affiliation(s)
- Emad Lotfalizadeh
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Maxime Ronot
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
- University Paris Diderot, Sorbonne Paris Cité, Paris, France.
- INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Mathilde Wagner
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
- INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Jérôme Cros
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Anne Couvelard
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Marie-Pierre Vullierme
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Wassim Allaham
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Olivia Hentic
- Department of Gastroenterology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Philippe Ruszniewski
- Department of Gastroenterology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Valérie Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
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de Mestier L, Lepage C, Baudin E, Coriat R, Courbon F, Couvelard A, Do Cao C, Frampas E, Gaujoux S, Gincul R, Goudet P, Lombard-Bohas C, Poncet G, Smith D, Ruszniewski P, Lecomte T, Bouché O, Walter T, Cadiot G. Digestive Neuroendocrine Neoplasms (NEN): French Intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, GTE, RENATEN, TENPATH, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR). Dig Liver Dis 2020; 52:473-492. [PMID: 32234416 DOI: 10.1016/j.dld.2020.02.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/08/2020] [Accepted: 02/24/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This document is a summary of the French Intergroup guidelines regarding the management of digestive neuroendocrine neoplasms (NEN) published in February 2020 (www.tncd.org). METHODS All French medical societies involved in the management of NEN took part in this work. Recommendations were graded into four categories (A, B, C or D), according to the level of evidence found in the literature until May 2019. RESULTS The management of NEN is challenging because of their heterogeneity and the increasing complexity of diagnostic and therapeutic procedures. Pathological analysis is required for their diagnostic and prognostic characterization, which mainly relies on differentiation, grade and stage. The two main emergency situations are functioning syndromes and poorly-differentiated carcinoma. Chromogranin A is the main biochemical marker of NET, although of limited clinical interest. Initial characterization relies on morphological and isotopic imaging. The treatment of localized NET relies on watchful follow-up and local or surgical resection depending on its supposed aggressiveness. Treatment options for metastatic disease include surgery, somatostatin analogues, chemotherapy, targeted therapies, organ-driven locoregional therapies and peptide-receptor radionuclide therapy. As specific predictive factors of treatment efficacy are yet to be identified and head-to-head comparisons have not or only rarely been performed, the therapeutic strategy currently depends on prognostic factors. Cumulative toxicity and the impact of treatment on quality of life must be considered since survival is relatively long in most patients with NET. CONCLUSION These guidelines are proposed to achieve the most beneficial therapeutic strategy in clinical practice as the therapeutic landscape of NEN is becoming ever more complex. These recommendations are permanently being reviewed.
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Affiliation(s)
- Louis de Mestier
- Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon Hospital (APHP) and Université de Paris, Clichy, France
| | - Come Lepage
- Department of Gastroenterology and Digestive Oncology, Dijon University Hospital, EPICAD INSERM LNC UMR 1231, University of Burgundy Dijon, France
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Gustave-Roussy Institute, Villejuif, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital (APHP) and Université de Paris, Paris, France
| | - Frédéric Courbon
- Department of Nuclear Medicine, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Anne Couvelard
- Department of Pathology of Bichat-Beaujon Hospitals (APHP), ENETS Centre of Excellence and Université de Paris, Paris, France
| | - Christine Do Cao
- Department of Endocrinology, Hôpital Claude Huriez, Lille University Hospital, Lille, France
| | - Eric Frampas
- Department of Radiology, Nantes University Hospital, Nantes, France
| | - Sébastien Gaujoux
- Department of Endocrine and Pancreatic Surgery, Cochin Hospital (APHP) and University of Paris, Paris, France
| | - Rodica Gincul
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Pierre Goudet
- Department of Endocrine Surgery, Dijon University Hospital and University of Burgundy, Dijon, France
| | - Catherine Lombard-Bohas
- Department of Oncology, ENETS Centre of Excellence, Hospices Civils de Lyon and Lyon University, Lyon, France
| | - Gilles Poncet
- Department of Digestive Surgery, ENETS Centre of Excellence, Edouard Herriot Hospital and Lyon University, Lyon, France
| | - Denis Smith
- Department of Digestive Oncology, Haut-Lévèque Hospital and University of Bordeaux, Pessac, France
| | - Philippe Ruszniewski
- Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon Hospital (APHP) and Université de Paris, Clichy, France
| | - Thierry Lecomte
- Department of Gastroenterology and Digestive Oncology, Tours University Hospital, Tours, France
| | - Olivier Bouché
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré University Hospital, Reims, France
| | - Thomas Walter
- Department of Oncology, ENETS Centre of Excellence, Hospices Civils de Lyon and Lyon University, Lyon, France
| | - Guillaume Cadiot
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré University Hospital, Reims, France.
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de Mestier L, Lacombe C, Couvelard A, Ruszniewski P, Cros J. Could pancreatic grade 3 neuroendocrine tumors really behave similarly to neuroendocrine carcinomas following resection? HPB (Oxford) 2020; 22:792. [PMID: 32224077 DOI: 10.1016/j.hpb.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Louis de Mestier
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM U1149, Centre of Research on Inflammation, France.
| | - Caroline Lacombe
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM U1149, Centre of Research on Inflammation, France
| | - Anne Couvelard
- Université de Paris, France; INSERM U1149, Centre of Research on Inflammation, France; Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon Hospital, Clichy, Paris, France
| | - Philippe Ruszniewski
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM U1149, Centre of Research on Inflammation, France
| | - Jérôme Cros
- Université de Paris, France; INSERM U1149, Centre of Research on Inflammation, France; Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon Hospital, Clichy, Paris, France
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Strosberg J, Kunz PL, Hendifar A, Yao J, Bushnell D, Kulke MH, Baum RP, Caplin M, Ruszniewski P, Delpassand E, Hobday T, Verslype C, Benson A, Srirajaskanthan R, Pavel M, Mora J, Berlin J, Grande E, Reed N, Seregni E, Paganelli G, Severi S, Morse M, Metz DC, Ansquer C, Courbon F, Al-Nahhas A, Baudin E, Giammarile F, Taïeb D, Mittra E, Wolin E, O'Dorisio TM, Lebtahi R, Deroose CM, Grana CM, Bodei L, Öberg K, Polack BD, He B, Mariani MF, Gericke G, Santoro P, Erion JL, Ravasi L, Krenning E. Impact of liver tumour burden, alkaline phosphatase elevation, and target lesion size on treatment outcomes with 177Lu-Dotatate: an analysis of the NETTER-1 study. Eur J Nucl Med Mol Imaging 2020; 47:2372-2382. [PMID: 32123969 PMCID: PMC7396396 DOI: 10.1007/s00259-020-04709-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the impact of baseline liver tumour burden, alkaline phosphatase (ALP) elevation, and target lesion size on treatment outcomes with 177Lu-Dotatate. METHODS In the phase 3 NETTER-1 trial, patients with advanced, progressive midgut neuroendocrine tumours (NET) were randomised to 177Lu-Dotatate (every 8 weeks, four cycles) plus octreotide long-acting release (LAR) or to octreotide LAR 60 mg. Primary endpoint was progression-free survival (PFS). Analyses of PFS by baseline factors, including liver tumour burden, ALP elevation, and target lesion size, were performed using Kaplan-Meier estimates; hazard ratios (HRs) with corresponding 95% CIs were estimated using Cox regression. RESULTS Significantly prolonged median PFS occurred with 177Lu-Dotatate versus octreotide LAR 60 mg in patients with low (< 25%), moderate (25-50%), and high (> 50%) liver tumour burden (HR 0.187, 0.216, 0.145), and normal or elevated ALP (HR 0.153, 0.177), and in the presence or absence of a large target lesion (diameter > 30 mm; HR, 0.213, 0.063). Within the 177Lu-Dotatate arm, no significant difference in PFS was observed amongst patients with low/moderate/high liver tumour burden (P = 0.7225) or with normal/elevated baseline ALP (P = 0.3532), but absence of a large target lesion was associated with improved PFS (P = 0.0222). Grade 3 and 4 liver function abnormalities were rare and did not appear to be associated with high baseline liver tumour burden. CONCLUSIONS 177Lu-Dotatate demonstrated significant prolongation in PFS versus high-dose octreotide LAR in patients with advanced, progressive midgut NET, regardless of baseline liver tumour burden, elevated ALP, or the presence of a large target lesion. Clinicaltrials.gov : NCT01578239, EudraCT: 2011-005049-11.
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Affiliation(s)
- Jonathan Strosberg
- Gastrointestinal Department/Neuroendocrine Tumor Division, Moffitt Cancer Center, Tampa, FL, USA.
| | - Pamela L Kunz
- Department of Medicine - Med/Oncology, Stanford University Medical Center, Stanford, CA, USA
| | - Andrew Hendifar
- Department of Internal Medicine/Hematology/Oncology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - James Yao
- Department of Gastrointestinal Medicinal Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Bushnell
- Department of Radiology, The University of Iowa, Iowa City, IA, USA
| | - Matthew H Kulke
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Richard P Baum
- Department of Nuclear Medicine, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Martyn Caplin
- Department of Gastroenterology and Tumour Neuroendocrinology, Royal Free Hospital, London, UK
| | | | - Ebrahim Delpassand
- Department of Clinical Nuclear Medicine, Excel Diagnostics Imaging Clinic, Houston, TX, USA
| | - Timothy Hobday
- Department of Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Chris Verslype
- Department of Hepatology, University Hospitals and KU Leuven, Leuven, Belgium
| | - Al Benson
- Hematology Oncology Division, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Rajaventhan Srirajaskanthan
- Department of Gastroenterology and General Internal Medicine, King's College Hospital - NHS Foundation Trust, London, UK
| | - Marianne Pavel
- Division of Hepatology and Gastroenterology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Jaume Mora
- Department of Nuclear Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jordan Berlin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Enrique Grande
- Department of Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | - Nicholas Reed
- Department of Medical Oncology, Beatson Oncology Centre, Glasgow, UK
| | - Ettore Seregni
- Department of Nuclear Medicine Therapy and Endocrinology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Paganelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Stefano Severi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Michael Morse
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - David C Metz
- GI Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine Ansquer
- Nuclear Medicine Department, Hôtel Dieu, University Hospital, Nantes, France
| | - Frédéric Courbon
- Medical Imaging, Oncology University Institut Claudius Regaud, Toulouse, France
| | - Adil Al-Nahhas
- Division of Imaging and Interventional Radiology, Imperial College London, London, UK
| | - Eric Baudin
- Department of Endocrine Oncology and Nuclear Medicine, Institut Gustave Roussy, Villejuif, France
| | - Francesco Giammarile
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - David Taïeb
- Department of Nuclear Medicine, Hôpital de la Timone, Marseille, France
| | - Erik Mittra
- Department of Nuclear Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Edward Wolin
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas M O'Dorisio
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Rachida Lebtahi
- Department of Nuclear Medicine, Royal Free Hospital, London, UK
| | - Christophe M Deroose
- Nuclear Medicine Department, University Hospitals and KU Leuven, Leuven, Belgium
| | - Chiara M Grana
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, Milan, Italy
| | - Lisa Bodei
- Department of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kjell Öberg
- Department of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Berna Degirmenci Polack
- Department of Medical Information, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Beilei He
- Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Maurizio F Mariani
- Research and Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Germo Gericke
- Research and Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Paola Santoro
- Department of Clinical Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Jack L Erion
- Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Laura Ravasi
- Research and Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Eric Krenning
- Department of Nuclear Medicine, Cyclotron Rotterdam BV, Erasmus University Medical Center, Rotterdam, Netherlands
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de Mestier L, Védie AL, Faron M, Cros J, Rebours V, Hentic O, Do Cao C, Bardet P, Lévy P, Sauvanet A, Ruszniewski P, Hammel P. The Postoperative Occurrence or Worsening of Diabetes Mellitus May Increase the Risk of Recurrence in Resected Pancreatic Neuroendocrine Tumors. Neuroendocrinology 2020; 110:967-976. [PMID: 31791037 DOI: 10.1159/000505158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The goal of this retrospective study was to investigate the potential link between diabetes mellitus (DM) and the recurrence of pancreatic neuroendocrine tumors (PanNET) following curative intent surgery. METHODS We included patients who underwent surgical resection of nonmetastatic well-differentiated PanNET. Exacerbation of DM was defined as the postoperative occurrence of DM or worsening of preexisting DM. We explored the variables associated with PanNET recurrence-free survival (RFS). RFS was compared in a subset of patients with and without DM operated on by anatomical resection, after matching for the main prognostic factors. The impact of antidiabetic therapy on RFS was assessed. RESULTS A total of 268 patients (median age 54.7, 40% men) were included. Most PanNET were sporadic (85%), G1 (61%), pT1/pT2 (79%), and pN0 (76%). Postoperative DM exacerbation occurred in 38 patients (14%), including 27 with new-onset DM. On multivariable analysis, DM exacerbation was independently associated with an increased risk of PanNET recurrence (HR 2.35, 95% CI [1.24-4.47], p = 0.009) after adjustment for age, multiplicity of tumors, grade, pT, and pN stages. Similar results were found when 27 patients with and 48 patients without DM exacerbation, matched for grade, pT stage and pN stage, were compared (HR 3.03, 95% CI [1.05-8.77], p = 0.032). The postoperative use of metformin tended to decrease the risk of recurrence (HR 0.59, 95% CI 0.24-1.47, p = 0.26). CONCLUSION Patients with postoperative DM exacerbation may have an increased risk of PanNET recurrence. Closer follow-up might be beneficial in these patients. The protective role of metformin should be further explored.
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Affiliation(s)
- Louis de Mestier
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France,
- Université de Paris, Paris, France,
- INSERM U1149, Centre de Recherche sur l'Inflammation, Clichy/Paris, France,
| | - Anne-Laure Védie
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
- Université de Paris, Paris, France
| | - Matthieu Faron
- Department of Surgical Oncology and Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jérôme Cros
- Université de Paris, Paris, France
- INSERM U1149, Centre de Recherche sur l'Inflammation, Clichy/Paris, France
- Department of Pathology, ENETS Centre of Excellence, Beaujon/Bichat Hospitals (APHP), Clichy/Paris, France
| | - Vinciane Rebours
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
- Université de Paris, Paris, France
- INSERM U1149, Centre de Recherche sur l'Inflammation, Clichy/Paris, France
| | - Olivia Hentic
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - Christine Do Cao
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital, Lille, France
| | - Pascal Bardet
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
| | - Philippe Lévy
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
- Université de Paris, Paris, France
| | - Alain Sauvanet
- Université de Paris, Paris, France
- Department of Hepato-Bilio-Pancreatic Surgery, ENETS Centre of Excellence, Beaujon/Bichat Hospitals (APHP), Clichy, France
| | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
- Université de Paris, Paris, France
- INSERM U1149, Centre de Recherche sur l'Inflammation, Clichy/Paris, France
| | - Pascal Hammel
- Université de Paris, Paris, France
- Department of Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
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de Mestier L, Armani M, Cros J, Hentic O, Rebours V, Cadiot G, Sauvanet A, Couvelard A, Lebtahi R, Ruszniewski P. Lesion-by-lesion correlation between uptake at FDG PET and the Ki67 proliferation index in resected pancreatic neuroendocrine tumors. Dig Liver Dis 2019; 51:1720-1724. [PMID: 31350186 DOI: 10.1016/j.dld.2019.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/26/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ki67 proliferation index and tumor uptake on 18fluorodeoxyglucose positron-emitting tomography (FDG-PET) could be correlated in pancreatic neuroendocrine tumors (PanNET), but the evaluation of the former is subject to tumor heterogeneity. AIMS Explore the correlation between Ki67 and FDG-PET uptake at the lesion scale in PanNET. METHODS We identified target lesions ≥10 mm in patients operated on for a PanNET and/or associated metastases with preoperative FDG-PET and without neoadjuvant treatment. We assessed the lesion-by-lesion correlation between Ki67 and the tumor-to-liver SUVmax ratio (SUVmax T/L), and between pathological grade (G) and metabolic grade (mG) (mG1, SUVmax T/L ≤ 1, mG2, SUVmax T/L 1-2.3 and mG3, SUVmax T/L > 2.3). RESULTS Twenty-one patients underwent pancreatic (n = 12), liver (n = 2) or combined surgery (n = 7). Overall, 36 target lesions (21 primary PanNET, 13 liver metastases and 2 lymph-node metastases) were identified, of median Ki67 4%. Ki67 correlated with SUVmax T/L (r = 0.55, p < 0.001). Median SUVmax T/L was 0.76, 1.41 and 2.67 for lesions G1, G2 and G3, respectively (p = 0.005). Median Ki67 was 1, 4 and 25 for lesions mG1, mG2 and mG3, respectively (p = 0.005). CONCLUSIONS Uptake on FDG-PET could predict the pathological grade of PanNET lesions. Hence, FDG-PET could supplement pathological evaluation of tumor biological aggressiveness and could guide the choice of the most relevant lesions to biopsy.
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Affiliation(s)
- Louis de Mestier
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France; Université de Paris, Paris, France; INSERM U1149, Beaujon Hospital, Clichy, France.
| | - Margot Armani
- Department of Nuclear Medicine, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France
| | - Jérôme Cros
- Université de Paris, Paris, France; INSERM U1149, Beaujon Hospital, Clichy, France; Department of Pathology, ENETS Centre of Excellence, Beaujon-Bichat Hospitals, APHP, Clichy/Paris, France
| | - Olivia Hentic
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France
| | - Vinciane Rebours
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France; Université de Paris, Paris, France; INSERM U1149, Beaujon Hospital, Clichy, France
| | - Guillaume Cadiot
- Department of Gastroenterology and Digestive Oncology, Robert-Debré Hospital, Reims, France
| | - Alain Sauvanet
- Université de Paris, Paris, France; INSERM U1149, Beaujon Hospital, Clichy, France; Department of Hepato-Bilio-Pancreatic Surgery, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France
| | - Anne Couvelard
- Université de Paris, Paris, France; INSERM U1149, Beaujon Hospital, Clichy, France; Department of Nuclear Medicine, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France
| | - Rachida Lebtahi
- Université de Paris, Paris, France; INSERM U1149, Beaujon Hospital, Clichy, France; Department of Nuclear Medicine, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France
| | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital, APHP, Clichy, France; Université de Paris, Paris, France; INSERM U1149, Beaujon Hospital, Clichy, France
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Capurso G, Gaujoux S, Pescatori LC, Panzuto F, Panis Y, Pilozzi E, Terris B, de Mestier L, Prat F, Rinzivillo M, Coriat R, Coulevard A, Delle Fave G, Ruszniewski P. The ENETS TNM staging and grading system accurately predict prognosis in patients with rectal NENs. Dig Liver Dis 2019; 51:1725-1730. [PMID: 31405587 DOI: 10.1016/j.dld.2019.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Factors associated with rectal NENs prognosis are poorly investigated. AIM To evaluate the prognostic role of the ENETs staging and grading systems in rectal NENs. METHODS Tertiary referral, multicenter, retrospective study. Factors associated with OS and PFS were investigated by Cox-regression analysis, with best size cut-offs calculated by ROC analysis. RESULTS Of 100 patients (mean age 55, 45% male, mean size 16.2 mm) 62, 5, 10 and 23 were TNM stage 1 to 4, and 63, 15 and 22 were G1, G2 and G3. Primary treatment was endoscopic snare resection in 62%, endoscopic mucosal resection/endoscopic submucosal dissection in 10%, surgery in 20% and medical treatment in 8%. The best size cut-offs to predict OS and PFS were 10 and 12 mm. During a mean follow-up of 40.7 months 12% died and 26% progressed. The 5-year OS and PFS were 79.5% and 65.2%. Stage IV and G3 were associated with worse OS (HR 8.16; p = 0.002; HR 15.57; p = 0.0004) and PFS (HR 14.26 p < 0.0001; HR 6.42; p = 0.0007). CONCLUSION Both staging and grading accurately predict rectal NENs prognosis. Size alone has limited accuracy as 26% of patients with stage IV and 16% with G3 have a primary tumour≤10 mm.
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Affiliation(s)
- Gabriele Capurso
- Digestive and Liver Disease Unit, S. Andrea Hospital, ENETs Center of Excellence, Rome, Italy; Pancreato-biliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, ENETs Center of Excellence, San Raffaele Scientific Institute IRCCS, Milan, Italy.
| | - Sebastien Gaujoux
- Department of Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Lorenzo Carlo Pescatori
- Digestive and Liver Disease Unit, S. Andrea Hospital, ENETs Center of Excellence, Rome, Italy
| | - Francesco Panzuto
- Digestive and Liver Disease Unit, S. Andrea Hospital, ENETs Center of Excellence, Rome, Italy
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, APHP, ENETs Center of Excellence, Clichy, France; University Denis Diderot - Paris VII, Paris, France
| | - Emanuela Pilozzi
- Pathology Unit, University Sapienza, S. Andrea Hospital, ENETs Center of Excellence, Rome, Italy
| | - Benoit Terris
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Pathology, Cochin Hospital, APHP, Paris, France
| | - Louis de Mestier
- University Denis Diderot - Paris VII, Paris, France; Department of Gastroenterology and Pancreatology, Beaujon Hospital, APHP, ENETs Center of Excellence, Clichy, France
| | - Frederic Prat
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Gastroenterology, Cochin Hospital, APHP, Paris, France
| | - Maria Rinzivillo
- Digestive and Liver Disease Unit, S. Andrea Hospital, ENETs Center of Excellence, Rome, Italy
| | - Romain Coriat
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Gastroenterology, Cochin Hospital, APHP, Paris, France
| | - Anne Coulevard
- University Denis Diderot - Paris VII, Paris, France; Department of Gastroenterology, Cochin Hospital, APHP, Paris, France
| | - Gianfranco Delle Fave
- Digestive and Liver Disease Unit, S. Andrea Hospital, ENETs Center of Excellence, Rome, Italy
| | - Philippe Ruszniewski
- University Denis Diderot - Paris VII, Paris, France; Department of Gastroenterology and Pancreatology, Beaujon Hospital, APHP, ENETs Center of Excellence, Clichy, France
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