Title of Article Clinicopathological characteristics of biliary...
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B A C K G R O U N D Neuroendocrine neoplasms (NENs) of the gallbladder (GB), extrahepatic bile duct (EHBD), and ampulla of Vater (AoV) are very rare. 1 Biliary NENs account for less than 1 percent of all gastrointestinal NENs. 1 According to the Surveillance, Epidemiology, and End Results (SEER) program and European studies, the incidence of NENs is increasing due to greater awareness and improved diagnostic tools. 2,3 The clinicopathology and prognosis of patients with different types of biliary NENs remain unclear. In this study, we tried to evaluate clinicopathology of biliary NENs and identify factors related to prognosis in affected patients. P A T I E N T S The Korean Gastroenteropancreatic Neuroendocrine Tumor Study Group of the Korean Society of Gastrointestinal Cancer conducted a multicenter retrospective study between 2005 and 2014. A total of 43 patients with biliary NENs were finally enrolled from 7 tertiary hospitals. The biliary NENs were in the GB (n=11), EHBD (n=5), or AoV (n=27). We compared the clinicopathology and outcome of patients with NENs in these different locations. W H O C L A S S F I C A T I O N The 2010 WHO classi fication was used to classify tumors as: neuroendocrine tumor (NET) G1 (mitotic count <2 per 10 high power fields [HPFs] and/or ≤2% Ki- 67 index); NET G2 (mitotic count 2- 20 per 10 HPFs and/or 3- 20% Ki- 67 index); neuroendocrine carcinoma (NEC) G3 (mitotic count >20 per 10 HPFs and/or >20% Ki- 67 index); or mixed adenoneuroendocrine carcinoma. 4 S T A T I S T I C A L A N A L Y S I S Categorical variables and continuous variables were compared by Fisher’s exact test and the Mann- Whitney U- test, respectively. Progression free survival and overall survival rates were compared by the log- rank test. Multiple Cox regression analysis was used to evaluate factors related to the overall survival. A p- value of 0.05 was considered statistically signi ficant. All statistical analyses were performed using SPSS version 12.0 for Windows (SPSS Inc. Chicago, IL, USA). A u t h o r s Kyong Joo Lee 1 , Jae Hee Cho, Sang Hyub Lee, Kwang Hyuk Lee, Byung Kyu Park, Jun Kyu Lee, Sang Myung Woo, Ji Kon Ryu, Jong Kyun Lee, Yeon Suk Kim, Jae Woo Kim, Woo Jin Lee E - m a i l [email protected] I n s t i t u t e 1 Department of Internal Medicine, Yonsei University Wonju College of Medicine C i t y / N a t i o n a l i t y Wonju, Korea C a t e g o r y Review Case Upper GI Lower GI Pancreatobiliary tract Others Title of Article C l i n i c o p a t h o l o g i c a l c h a r a c t e r i s t i c s o f b i l i a r y n e u r o e n d o c r i n e n e o p l a s m a m u l t i c e n t e r s t u d y R E S U L T S We examined the records of 43 patients with biliary NENs (T a b l e 1 ). The median age was 62 years (range: 29- 84 years) and there were 25 males (58.1%) and 18 females (41.9%). The most common symptoms at diagnosis were abdominal pain and jaundice. There were incidental diagnoses during regular check- ups in 2 patients (18.2%) who had GB NENs and in 9 patients (33.3%) who had AoV NENs. The most common metastatic site was the liver. According to the WHO classi fication, all of patients with GB NENs had NEC G3 and 37.1% of patients with AoV NENs were classi fied as NEC G3.
Transcript of Title of Article Clinicopathological characteristics of biliary...
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BACKGROUND
Neuroendocrine neoplasms (NENs) of the gallbladder (GB), extrahepatic bile duct (EHBD), and ampulla of Vater (AoV) are very rare.1 Biliary NENsaccount for less than 1 percent of all gastrointestinal NENs.1 According to the Surveillance, Epidemiology, and End Results (SEER) program andEuropean studies, the incidence of NENs is increasing due to greater awareness and improved diagnostic tools.2,3 The clinicopathology andprognosis of patients with different types of biliary NENs remain unclear. In this study, we tried to evaluate clinicopathology of biliary NENs andidentify factors related to prognosis in affected patients.
PATIENTS
The Korean Gastroenteropancreatic Neuroendocrine Tumor Study Group of the Korean Society of Gastrointestinal Cancer conducted a multicenterretrospective study between 2005 and 2014. A total of 43 patients with biliary NENs were finally enrolled from 7 tertiary hospitals. The biliary NENswere in the GB (n=11), EHBD (n=5), or AoV (n=27). We compared the clinicopathology and outcome of patients with NENs in these different locations.
WHO CLASSFICATION
The 2010 WHO classification was used to classify tumors as: neuroendocrine tumor (NET) G1 (mitotic count 20per 10 HPFs and/or >20% Ki- 67 index); or mixed adenoneuroendocrine carcinoma.4
STATISTICAL ANALYSIS
Categorical variables and continuous variables were compared by Fisher’s exact test and the Mann- Whitney U- test, respectively. Progression freesurvival and overall survival rates were compared by the log- rank test. Multiple Cox regression analysis was used to evaluate factors related to theoverall survival. A p- value of 0.05 was considered statistically significant. All statistical analyses were performed using SPSS version 12.0 forWindows (SPSS Inc. Chicago, IL, USA).
Authors Kyong Joo Lee1, Jae Hee Cho, Sang Hyub Lee, Kwang Hyuk Lee, Byung Kyu Park, Jun Kyu Lee, Sang Myung Woo, Ji KonRyu, Jong Kyun Lee, Yeon Suk Kim, Jae Woo Kim, Woo Jin Lee
E- mail [email protected]
Institute 1Department of Internal Medicine, Yonsei University Wonju College of Medicine
City/Nationality Wonju, Korea
Category Review
Case
Upper GI Lower GI Pancreatobiliary tract Others
Title of Article
Clinicopathological characteristics of biliary neuroendocrine neoplasmamulticenter study
RESULTS
We examined the records of 43 patients with biliary NENs (Table 1). The median age was 62 years (range: 29- 84 years) and there were 25 males(58.1%) and 18 females (41.9%). The most common symptoms at diagnosis were abdominal pain and jaundice. There were incidental diagnosesduring regular check- ups in 2 patients (18.2%) who had GB NENs and in 9 patients (33.3%) who had AoV NENs. The most common metastatic sitewas the liver. According to the WHO classification, all of patients with GB NENs had NEC G3 and 37.1% of patients with AoV NENs were classified asNEC G3.
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In conclusion, our multivariate analysis indicated that patients with biliary NENs classified as G3 by the 2010 WHO classification had poor prognosesirrespective of the tumor site and metastasis. In addition, because most AoV NENs are classified as G1 or G2, patients with these tumors have morefavorable prognoses. Further prospective studies are needed to establish the prognostic factors for patients with biliary NENs.
< Lee KJ, Cho JH, Lee SH, Lee KH, Park BK, Lee JK, et al. Scand J Gastroenterol 2017;52(4):437-441.
FIGURE
FIGURE 1 Kaplan- Meier survival curves of progression free survival between patients with GB NENs an
FIGURE 2 Kaplan- Meier survival curves of overall survival between patients with GB NENs and AoV NE
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TABLETABLE 1 Clinicopathological features of biliary neuroendocrine neoplasms
Gallbladder EHBD Ampulla of Vater
(n=11) (n=5) (n=27)
Median age, years 62 (range, 31- 84) 74 (range, 54- 84) 60 (range, 29- 77)
Sex
Male 6 (54.5%) 4 (80%) 15 (55.6%)
Female 5 (45.5%) 1 (20%) 12 (44.4%)
Symptoms
Abdominal pain 8 (72.7%) 2 (40%) 7 (25.9%)
Jaundice 2 (18.2%) 2 (40%) 7 (25.9%)
Weight loss 1 (9.1%) 0 1 (3.7%)
Incidental diagnosis 2 (18.2%) 1 (20%) 9 (33.3%)
Coexistence
Diabetes mellitus 1 (9.1%) 0 2 (7.4%)
Gallbladder stone 0 0 1 (3.7%)
Choledocholithiasis 1 (9.1%) 0 0
Initial metastasis
Liver 7 (73.6%) 0 5 (18.5%)
Lymph nodes 2 (18.2%) 0 1 (3.7%)
WHO classification (2010)
NEN G1 0 1 (20%) 13 (48.1%)
NEN G2 0 0 4 (14.8%)
NEC G3 11 (100%) 4 (80%) 10 (37.1%)
Initial treatment
Operation 7 (63.6%) 5 (100%) 21 (77.8%)
Endoscopic resection 0 0 3 (11.1%)
Chemotherapy 3 (27.3%) 0 1 (3.7%)
Conservative care 1 (9.1%) 0 2 (7.4%)
Curative resection (R0) 3 (27.3%) 3 (60%) 16 (59.3%)
EHBD, extrahepatic bile duct; WHO, World Health Organization; NEN, neuroendocrine neoplasm; NEC, neuroendocrine carcinoma
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Characteristic HR P- value* HR 95% CI P- value**
Age
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