Laboratory variables as predictors of progression in gastroenteropancreatic neuroendocrine tumors in different lines of antineoplastic treatments

Objective:

To determine the association of red cell blood counts, and liver panel tests to predict outcomes in patients with gastroenteropancreatic neuroendocrine tumors who underwent systemic antineoplastic treatments.

Methods:

Patients with gastroenteropancreatic neuroendocrine tumors in systemic treatment were assessed according to laboratory tests within the same period. Progression free survival was determined by the period between the beginning of treatment and the date of progression. We used conditional models (PWP model) to verify the association between laboratory tests and tumor progression. The level of significance used was 5%.

Results:

A total of 30 treatments given to 17 patients in the intention-to-treat population were evaluated. Treatment included octreotide, lanreotide, everolimus, lutetium, and chemotherapy. We had statistically significant results in chromogranin A, neutrophils and platelets-to-lymphocyte ratio. The risk of progression increases by 2% with the addition of 100ng/mL of chromogranin A (p=0.034), 4% with the increase of 100 neutrophil units (p=0.006), and 21% with the addition of 10 units in platelets-to-lymphocyte ratio (p=0.002).

Conclusion:

Chromogranin A, neutrophils and platelets-to-lymphocyte ratio were associated with disease progression during systemic treatment in gastroenteropancreatic neuroendocrine tumors. Further prospective studies with larger cohorts are necessary to validate our findings.

Chylous ascites in gynecologic malignancies: cases report and literature review

PURPOSE

Chylous ascites is an infrequent postoperative complication after retroperitoneal surgical procedure. Despite its infrequent occurrence, postoperative chylous ascites are associated with significant morbidity. Reports of chylous ascites or fistula after retroperitoneal lymph node dissection for gynecologic malignancies without radiation therapy are rare. A search in the English literature showed only 31 cases of chylous fistula for gynecologic malignancies. Treatment may be conservative with low-fat oral diet with medium-chain triglycerides associated or not to octreotide and total parenteral nutrition. In case of conservative measures failure, it can be managed by surgical intervention or peritoneo-venous shunt.

METHODS

We report two cases of chylous fistula following systematic pelvic and retroperitoneal lymph node dissection for gynecological cancer without radiotherapy and review the literature.

RESULTS

Both were successfully managed with the maintenance of the postoperative drain, total parenteral nutrition, octreotide and dietary intervention.

CONCLUSIONS

Chylous ascites should be included in differential diagnosis of abdominal distention after surgical retroperitoneal approach or radiotherapy. Most of the patients may have their chylous ascites successfully treated with conservative management. However, the best policy is to prevent chylous complications by employing meticulous dissection techniques and careful control of the major lymphatics by suture ligation during the primary surgical intervention.