Metastatic Potential and Survival of Duodenal and Pancreatic Tumors in Multiple Endocrine Neoplasia Type 1

Sandrine Vinault 1, 2, 3 Anne-Sophie Mariet 4, 1 Maëlle Le Bras 5 Eric Mirallié 6 Catherine Cardot-Bauters 7 Francois Pattou 8, 9 Philippe Ruszniewski 10, 11 Alain Sauvanet 12 Philippe Chanson 13, 14 Eric Baudin 15 Dominique Elias 16 Fabrice Menegaux 17 Sebastien Gaujoux 18, 19 François Borson-Chazot 20, 21 Jean-Christophe Lifante 20, 22 Philippe Caron 23 Nicolas Carrere 24 Antoine Tabarin 25 Christophe Laurent 26, 27 Marc Klein 28 Laurent Brunaud 29 Patricia Niccoli 30 Frédéric Sebag 31 Guillaume Cadiot 32 Reza Kianmanesh 32 Maxime Luu 33 Christine Binquet 1, 2, 3 Pierre Goudet 34, 2, 3
15 Médecine nucléaire
Département d'imagerie médicale [Gustave Roussy]
33 PIT - Plateforme d’Investigation Technologique [Centre d’Investigation Clinique 1432 module Plurithématique - Dijon]
CAPS - Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093], CIC-P803 - Centre d'Investigation Clinique 1432 (Dijon) - Module Plurithématique : Périnatalité Cancérologie Handicap et Ophtalmologie
Abstract : Objective: To assess the distant metastatic potential of duodeno-pancreatic neuroendocrine tumors (DP-NETs) in patients with MEN1, according to functional status and size. Summary Background Data: DP-NETs, with their numerous lesions and endocrine secretion-related symptoms, continue to be a medical challenge; unfortunately they can become aggressive tumors associated with distant metastasis, shortening survival. The survival of patients with large nonfunctional DP-NETs is known to be poor, but the overall contribution of DP-NETs to metastatic spread is poorly known. Methods: The study population included patients with DP-NETs diagnosed after 1990 and followed in the MEN1 cohort of the Groupe d’étude des Tumeurs Endocrines (GTE). A multistate Markov piecewise constant intensities model was applied to separate the effects of prognostic factors on 1) metastasis, and 2) metastasis-free death or 3) death after appearance of metastases. Results: Among the 603 patients included, 39 had metastasis at diagnosis of DP-NET, 50 developed metastases during follow-up, and 69 died. The Markov model showed that Zollinger-Ellison-related tumors (regardless of tumor size and thymic tumor pejorative impact), large tumors over 2 cm, and age over 40 years were independently associated with an increased risk of metastases. Men, patients over 40 years old and patients with tumors larger than 2 cm, also had an increased risk of death once metastasis appeared. Conclusions: DP-NETs of 2 cm in size or more, regardless of the associated secretion, should be removed to prevent metastasis and increase survival. Surgery for gastrinoma remains debatable.
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https://hal-univ-bourgogne.archives-ouvertes.fr/hal-01996226
Contributeur : Lnc - Université de Bourgogne <>
Soumis le : lundi 28 janvier 2019 - 11:23:57
Dernière modification le : vendredi 14 juin 2019 - 18:31:22

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Sandrine Vinault, Anne-Sophie Mariet, Maëlle Le Bras, Eric Mirallié, Catherine Cardot-Bauters, et al.. Metastatic Potential and Survival of Duodenal and Pancreatic Tumors in Multiple Endocrine Neoplasia Type 1. Annals of Surgery, Lippincott, Williams & Wilkins, In press, ⟨https://journals.lww.com/annalsofsurgery/Abstract/publishahead/Metastatic_Potential_and_Survival_of_Duodenal_and.95290.aspx⟩. ⟨10.1097/SLA.0000000000003162⟩. ⟨hal-01996226⟩

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