title: Predictive and prognostic factors for treatment and survival in 305 patients with advanced gastrointestinal neuroendocrine carcinoma (WHO G3): the NORDIC NEC study.
abstract: BACKGROUND
  As studies on gastrointestinal neuroendocrine carcinoma (WHO G3) (GI-NEC) are limited, we reviewed clinical data to identify predictive and prognostic markers for advanced GI-NEC patients.
  
  
  METHODS
  Data from advanced GI-NEC patients diagnosed 2000-2009 were retrospectively registered at 12 Nordic hospitals.
  
  
  RESULTS
  The median survival was 11 months in 252 patients given palliative chemotherapy and 1 month in 53 patients receiving best supportive care (BSC) only. The response rate to first-line chemotherapy was 31% and 33% had stable disease. Ki-67<55% was by receiver operating characteristic analysis the best cut-off value concerning correlation to the response rate. Patients with Ki-67<55% had a lower response rate (15% versus 42%, P<0.001), but better survival than patients with Ki-67≥55% (14 versus 10 months, P<0.001). Platinum schedule did not affect the response rate or survival. The most important negative prognostic factors for survival were poor performance status (PS), primary colorectal tumors and elevated platelets or lactate dehydrogenase (LDH) levels.
  
  
  CONCLUSIONS
  Advanced GI-NEC patients should be considered for chemotherapy treatment without delay.PS, colorectal primary and elevated platelets and LDH levels were prognostic factors for survival. Patients with Ki-67<55% were less responsive to platinum-based chemotherapy, but had a longer survival. Our data indicate that it may not be correct to consider all GI-NEC as one single disease entity.
authors.affiliation: Department of Oncology, Haukeland University Hospital, Bergen, Norway. halfdan.sorbye@helse-bergen.no
authors.forename: H
authors.initials: H
authors.lastname: Sorbye
authors.forename: S
authors.initials: S
authors.lastname: Welin
authors.forename: S W
authors.initials: SW
authors.lastname: Langer
authors.forename: L W
authors.initials: LW
authors.lastname: Vestermark
authors.forename: N
authors.initials: N
authors.lastname: Holt
authors.forename: P
authors.initials: P
authors.lastname: Osterlund
authors.forename: S
authors.initials: S
authors.lastname: Dueland
authors.forename: E
authors.initials: E
authors.lastname: Hofsli
authors.forename: M G
authors.initials: MG
authors.lastname: Guren
authors.forename: K
authors.initials: K
authors.lastname: Ohrling
authors.forename: E
authors.initials: E
authors.lastname: Birkemeyer
authors.forename: E
authors.initials: E
authors.lastname: Thiis-Evensen
authors.forename: M
authors.initials: M
authors.lastname: Biagini
authors.forename: H
authors.initials: H
authors.lastname: Gronbaek
authors.forename: L M
authors.initials: LM
authors.lastname: Soveri
authors.forename: I H
authors.initials: IH
authors.lastname: Olsen
authors.forename: B
authors.initials: B
authors.lastname: Federspiel
authors.forename: J
authors.initials: J
authors.lastname: Assmus
authors.forename: E T
authors.initials: ET
authors.lastname: Janson
authors.forename: U
authors.initials: U
authors.lastname: Knigge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018278:Carcinoma, Neuroendocrine / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000503:physiopathology / Q000628:therapy*; D049669:History, 16th Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D016019:Survival Analysis