TY - JOUR
TI - Distinctive features of pancreatic neuroendocrine neoplasms exhibiting an increment in proliferative activity during the course of the disease
AU - Alexandraki, K.I.
AU - Kaltsatou, M.
AU - Kyriakopoulos, G.
AU - Mavroeidi, V.
AU - Kostopoulou, A.
AU - Atlan, K.
AU - Theocharis, S.
AU - Rindi, G.
AU - Grossman, A.B.
AU - Grozinsky-Glasberg, S.
AU - Kaltsas, G.A.
JO - Endocrine Development
PY - 2021
VL - 72
TODO - 1
SP - 279-286
PB - Springer-Verlag
SN - null
TODO - 10.1007/s12020-020-02540-w
TODO - everolimus;  protein p53;  Ki 67 antigen, adult;  aged;  Article;  cancer grading;  cancer surgery;  cell structure;  clinical feature;  cohort analysis;  disease course;  disease exacerbation;  female;  follow up;  histopathology;  human;  human tissue;  immunohistochemistry;  major clinical study;  male;  middle aged;  morphology;  neuroendocrine tumor;  overall survival;  pancreas tumor;  priority journal;  proliferation index;  protein expression;  retrospective study;  survival time;  tumor biopsy;  very elderly;  cancer staging;  diagnostic test;  neuroendocrine tumor;  pancreas tumor;  pathology;  prognosis, Diagnostic Tests, Routine;  Humans;  Ki-67 Antigen;  Neoplasm Grading;  Neoplasm Staging;  Neuroendocrine Tumors;  Pancreatic Neoplasms;  Prognosis
TODO - Purpose: Neuroendocrine neoplasms (NENs) differ in their biological behavior and growth potential in a way that can be predicted using histological classification and grading systems. A subset of pancreatic NENs (pNENs) may develop a more aggressive phenotype during the course of the disease, associated with an increase in the Ki-67 proliferation index (PI). The purpose of the study was to present the clinical characteristics of these patients. Methods: Using re-biopsy of growing lesions, we investigated the increase in Ki-67 PI sufficient to change initial grading (G). Results: Of 264 patients with well differentiated (WD) pNENs who showed progressive disease during follow-up, 15 (6%) exhibited an increase in Ki-67 PI at a median time 36.8 (9.3–255.8) months. All neoplasms had WD-morphology: five had G1 (Ki-67 median value 1%), nine G2 (median value 5%), one G3 (25%) grades. Upon change of Ki-67 PI, 3 patients had G2 (8%) and 12 G3 (57.5%) NENs, while all retained their WD-morphology. At last follow-up, eight patients were alive with a median overall survival (OS) of 52.5 (9.5–264.3) months. Μedian OS was shorter in patients who had a change in Ki-67 PI before 36 months compared to those who had a change of Ki-67 PI at a later stage (27.5 95%CI: 11.88–43.06 vs. 120.87 95%CI: 96.05–145.69; log-rank p = 0.018). Conclusions: During the course of their disease, 6% patients with progressive pNENs develop an increase in Ki-67 PI resulting in an increase in grading status while maintaining their morphology. This process is associated with worse OS when it occurs at an early stage. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.
ER -