Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Ευανθία Διαμάντη – Κανδαράκη, Ομότιμη Καθηγήτρια Παθολογίας – Ενδοκρινολογίας, Ιατρική Σχολή, ΕΚΠΑ
Παρασκευή Ρούσσου, Ομότιμη Καθηγήτρια Παθολογίας – Αιματολογίας, Ιατρική Σχολή, ΕΚΠΑ
Μελπομένη Πέππα, Αναπληρώτρια Καθηγήτρια Ενδοκρινολογίας, Ιατρική Σχολή, ΕΚΠΑ
Κουτσιλιέρης Μιχαήλ, Καθηγητής Πειραματικής Φυσιολογίας, Ιατρική Σχολή, ΕΚΠΑ
Καλτσάς Γρηγόριος, Καθηγητής Παθολογίας – Ενδοκρινολογίας, Ιατρική Σχολή, ΕΚΠΑ
Λαμπρινουδάκη Ειρήνη, Καθηγήτρια Ενδοκρινολογίας, Ιατρική Σχολή, ΕΚΠΑ
Κασσή Ευανθία, Αναπληρώτρια Καθηγήτρια Ενδοκρινολογίας, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Μελέτη ασθενών με νευροενδοκρινείς όγκους: η εμπειρία πολυδύναμων, εξειδικευμένων ιατρείων στην Ελλάδα
Translated title:
Unraveling the incidence and clinical patterns of neuroendocrine neoplasms in Greece, through the experience of multipotent, specialized clinical centers
Summary:
INTRODUCTION: Neuroendocrine neoplasms (NENs) are a heterogenous group of indolent tumors, with variable clinical behavior and steadily rising incidence. Despite the progress made during the last 30 years, available epidemiological data are not enough to draw definite conclusion about the natural course of these tumors. Simultaneously, the paucity of reliable clinical or biochemical parameters able to guide clinicians in the diagnostic and therapeutic approach of these patients, complicates further their epidemiological and clinical evaluation.
AIM OF THE STUDY: The aim of this study is to evaluate the epidemiological, clinical and histopathological characteristics of patients with NENs, as well as to investigate the clinical and laboratory factors that contribute in predicting the aggressiveness and invasiveness of NENs. Special focus is given to clinical parameters that would enhance the diagnostic value of chromogranin A (CgA), via formalizing an integrated probability model, which would contribute to the timely and accurate identification of patients at high risk for metastatic disease at initial diagnosis.
STUDY DESIGN: We identified a total of 311 patients with NENs, recruited at a specialized academic center in Athens, Greece. Anthropometric, clinical, laboratory, and pathological data were obtained from every patient before any therapeutic intervention.
Results: In this cohort, 174 patients were women (55.9%) and 137 men (44.1%), with mean age at the time of diagnosis 52.77±16.7 years (range 26-82 years). The majority of NENs were detected in the gastronteropancreatic system, of which the most common primary site was stomach (23.8%, n=74), followed by pancreas (19.6%, n=61) and appendix (12.9%, n=40). In 31 patients (10%) the primary tumor remained unknown, despite extensive diagnostic workup. Age over 50 years and male gender were accompanied by increased risk for metastases at the time of initial diagnosis. Additionally, when these parameters were combined with CgA levels, they were shown to enhance the predictive capacity of CgA. Different patient scenarios combining age, gender, and CgA levels are associated with different probabilities for metastatic disease, demonstrated schematically in a gradually escalating model, as age and CgA levels increase in both males and females. The lowest risk is observed in women aged <50 years old with CgA levels <200 ng/dl (6.5%), while the highest one is in males over 50 years old with CgA > 200 ng/dl (62.9%). Finally, it was shown that c‐reactive protein (CRP) can predict disease extent at the time of diagnosis.
Conclusions: The majority of NENs were detected in the gastronteropancreatic system and were localized. Age over 50 years and male gender were associated with increased risk for metastases at the time of initial diagnosis. CgA levels can not only be used as a direct predictor of tumor load in patients with NENs, but also, when interpolated with the effects of age and gender, cumulatively predict whether a NEN would be metastatic or not at the time of initial diagnosis, via a risk‐escalating probability model.
Main subject category:
Health Sciences
Keywords:
Neuroendocrine neoplasms, Greece, Chromogranin A, Inflammatory markers, CRP
Number of references:
159
