Mixed neuroendocrine nonneuroendocrine neoplasms of the pancreas: a case report and literature review of pancreatic mixed neuroendocrine nonneuroendocrine neoplasm

Wang, Fei; Lou, Xin; Qin, Yi; Xu, Xiaowu; Lei, Yu; Huang, Dan; Ji, Shunrong

doi:10.21037/gs-21-564

Cited by 4 publications

(1 citation statement)

References 25 publications

(42 reference statements)

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“…NEN is a neoplasm with extremely high heterogeneity, which in some cases can be mixed with non-neuroendocrine components, resulting in significant differences in biological behavior, malignant potential and prognosis of NEN ( 25 ). NENs have been found in multiple organs, of which GEP-NENs are more common and thymic/lung NEN appear relatively rare ( 6 , 26 ).…”

Section: Discussionmentioning

confidence: 99%

Assessing the effectiveness and safety of surufatinib versus everolimus or sunitinib in advanced neuroendocrine neoplasms: insights from a real-world, retrospective cohort study using propensity score and inverse probability treatment weighting analysis

Zhu,

Ye,

She

et al. 2024

J Gastrointest Oncol

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Background While surufatinib, sunitinib, and everolimus have shown efficacy for advanced neuroendocrine neoplasms (NENs) in randomized controlled trials (RCTs), direct comparisons in a real-world setting remain unexplored. This gap highlights the clinical need to understand their comparative effectiveness and safety within the diverse Chinese population. Addressing this, our study provides insights into the real-world performance of these therapies, aiming to inform treatment selection and improve patient outcomes. Methods A retrospective, observational study was conducted at Fudan University Shanghai Cancer Center, including patients with advanced NENs treated with surufatinib, sunitinib, or everolimus between July 2020 and April 2023. Eligibility criteria focused on histologically confirmed, locally advanced, unresectable, or metastatic NENs, with patients having received at least one month of targeted therapy. We employed inverse probability weighting (IPW) with the propensity score (PS) matching to adjust for the bias of baseline characteristics. The assessment of covariates included age, sex, performance status, primary tumor site, functional status, genetic mutations, tumor differentiation, Ki67 index, tumor grade, metastasis site, and previous therapies. The primary outcome was progression-free survival (PFS), and secondary outcomes included objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Results The study enrolled 123, 56, and 68 locally advanced or metastatic NEN patients treated with surufatinib, sunitinib, and everolimus, respectively. Before adjusting for confounding factors, surufatinib was used less frequently as a first-line treatment compared to sunitinib and everolimus in pancreatic NENs (pNENs) (11.1% vs. 22.1%, P=0.057). Significant differences were noted in prior treatments and tumor characteristics between surufatinib and everolimus groups in extrapancreatic NENs (epNENs) (P<0.05). Post-IPW, these disparities were resolved (P>0.05). Surufatinib demonstrated superior median PFS (mPFS) in both pancreatic [8.30 vs. 6.33 months, hazard ratio (HR) 0.592, P<0.001] and epNENs (8.73 vs. 3.70 months, HR 0.608, P<0.001) compared to everolimus or sunitinib. Notably, male gender (HR 1.75, P=0.001), functional status (HR 2.09, P=0.01), Ki67 index >20% (HR 12.7, P=0.004), previous somatostatin analogue (SSA) treatment (HR 1.73, P=0.001), germline mutation (HR 5.62, P<0.001), poor differentiation (HR 7.45, P<0.001), liver metastasis (HR 1.72, P=0.001) and multiple treatment lines (HR 1.62 for 2 nd line, P=0.04; HR 1.88 for ≥3 rd line, P=0.01) were identified as negative prognostic factors for PFS. Conversely, dose adjustment (HR 0.63, P=0.009) and treatment with surufatinib (HR 0.58 for pNEN, P<0.001; HR 0.62 for epNEN, P=0.002) were correlated with longer PFS. ...

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Section: Discussionmentioning

confidence: 99%

Assessing the effectiveness and safety of surufatinib versus everolimus or sunitinib in advanced neuroendocrine neoplasms: insights from a real-world, retrospective cohort study using propensity score and inverse probability treatment weighting analysis

Zhu,

Ye,

She

et al. 2024

J Gastrointest Oncol

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Spatiotemporal heterogeneity and clinical challenge of pancreatic neuroendocrine tumors

Lou¹,

Qin²,

Xu³

et al. 2022

Biochimica et Biophysica Acta (BBA) - Reviews on Cancer

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Evaluating endoscopic ultrasound-guided tissue acquisition for diagnosis of small pancreatic neuroendocrine neoplasms

Katsuda,

Kobayashi,

Ito

et al. 2024

Endosc Int Open

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Objectives: Although small hypervascular tumors are suspected to be pancreatic neuroendocrine tumors (p-NENs), their diagnosis and treatment are challenging. This study evaluates the usefulness of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for the diagnosis of small p-NENs. Methods: All p-NEN lesions that underwent EUS-TA at our hospital between April 2018 and December 2023 were retrospectively analyzed. The diagnostic sensitivity of EUS-TA and the concordance rate of grading with EUS-TA and surgical specimens were examined. The lesions were grouped by size. Results: The diagnostic sensitivity of EUS-TA was analyzed for 82 lesions, of which 44 were compared with postoperative specimens for grading. The definitive diagnosis was neuroendocrine tumor (NET) in 75 lesions, neuroendocrine carcinoma in five lesions, and mixed neuroendocrine non-neuroendocrine neoplasm in two lesions. Thirty tumors were ≤ 10 mm, 30 were 10–20 mm, and 22 were > 20 mm, and the diagnostic sensitivities were 96.7%, 96.7%, and 90.9%, respectively. The concordance rates for grading were 94.4%, 82.4%, and 77.8% for tumors ≤ 10 mm, 10–20 mm, and ≥ 20 mm, respectively, with Cohen’s kappa coefficients of 0.64, 0.48, and 0.40, respectively. Conclusions: EUS-TA showed adequate diagnostic sensitivity and grading agreement for p-NENs of all sizes, allowing for the determination of the appropriate treatment.

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Mixed neuroendocrine nonneuroendocrine neoplasms of the pancreas: a case report and literature review of pancreatic mixed neuroendocrine nonneuroendocrine neoplasm

Cited by 4 publications

References 25 publications

Assessing the effectiveness and safety of surufatinib versus everolimus or sunitinib in advanced neuroendocrine neoplasms: insights from a real-world, retrospective cohort study using propensity score and inverse probability treatment weighting analysis

Assessing the effectiveness and safety of surufatinib versus everolimus or sunitinib in advanced neuroendocrine neoplasms: insights from a real-world, retrospective cohort study using propensity score and inverse probability treatment weighting analysis

Spatiotemporal heterogeneity and clinical challenge of pancreatic neuroendocrine tumors

Evaluating endoscopic ultrasound-guided tissue acquisition for diagnosis of small pancreatic neuroendocrine neoplasms

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