Περίληψη:
Simple Summary Virchow’s node metastasis (VM) refers to the involvement
of the left supraclavicular lymph nodes at the junction of the thoracic
duct and the left subclavian vein. Generally, VM is considered by
clinicians to be a strong indicator of metastatic abdominal malignancy,
and its dismal prognostic significance has previously been described in
patients with metastatic gastric and ovarian cancer. To date,
comprehensive descriptions of patients with small intestinal
neuroendocrine tumors (SI-NETs) and rare metastatic manifestations,
including that of VM, are sparse. In the present study from two tertiary
referral centers, the prevalence of the VM secondary to SI-NET primaries
was found to be 3.9%. VM was more often encountered in patients with
higher-grade tumors and established disseminated disease to distant
para-aortic lymph nodes. However, the presence of VM did not yield any
negative prognostic impact in patient outcomes when compared to age- and
sex-matched patients of similar grade with distant metastases confined
in the abdomen Small intestinal neuroendocrine tumors (SI-NETs) may
rarely metastasize to the left supraclavicular lymph nodes, also known
as Virchow’s node metastasis (VM). Data on prevalence, prognostic
significance, and clinical course of disease for SI-NET patients with VM
is limited. In this retrospective analysis of 230 SI-NET patients
treated at two tertiary referral centers, we found nine patients with VM
(prevalence 3.9%). Among those, there were 5 females and median age at
SI-NET and VM diagnosis was 61 and 65 years, respectively. Two patients
had G1 tumors and five G2, while two tumors were of unspecified grade
(median Ki67: 7%, range 2-15%). Four patients presented with
synchronous VM, whereas five developed metachronous VM after a median of
twenty-four months (range: 4.8-117.6 months). Hepatic metastases were
present in seven patients, extrahepatic metastases (EM) in eight (six
para-aortic distant lymph node metastases, one lung and one pancreatic
metastasis), whereas peritoneal carcinomatosis (PC) in two patients. We
used a control group of 18 age- and sex-matched SI-NET patients from the
same cohort with stage IV disease but no extra-abdominal metastases.
There was no difference in best-recorded response to first line
treatment according to RECIST 1.1 as well as progression-free survival
(PFS) between patients with VM and those in the control group
(Chi-square test p = 0.516; PFS 71.7 vs. 106.9 months [95% CI
38.1-175.8]; log-rank p = 0.855). In addition, median overall survival
(OS) of SI-NET patients with VM did not differ from those in the control
group (138.6 [95% CI 17.2-260] vs. 109.9 [95% CI 91.7-128] months;
log-rank p = 0.533). In conclusion, VM, although relatively rare in
patients with SI-NETs, is more often encountered in patients with G2
tumors and established distant para-aortic lymph node metastases. The
presence of VM in SI-NET patients does not seem to impact patients’
survival outcomes and treatment responses, when compared to age- and
sex-matched SI-NET patients with stage IV disease confined in the
abdomen.
Συγγραφείς:
Wedin, Maria
Tsoli, Marina
Wallin, Goeran
Janson, Eva
Tiensuu
Koumarianou, Anna
Kaltsas, Gregory
Daskalakis,
Kosmas
