Gastroenteropancreatic high-grade neuroendocrine carcinoma.
Gastroenteropancreatic (GEP) neuroendocrine neoplasms are classified as low-grade, intermediate-grade, and high-grade tumors based on morphologic criteria and the proliferation rate. Most studies have been conducted in patients with well differentiated (low-grade to intermediate-grade) neuroendocrine tumors. Data are substantially scarcer on poorly differentiated, high-grade neuroendocrine carcinoma (NEC), which includes the entities of small cell carcinoma and large cell NEC. A literature search of GEP-NEC was performed. Long-term survival was poor even among patients who presented with localized disease. Several studies highlighted heterogeneity within the high-grade NEC category and a need for the further identification of discreet prognostic and predictive groups. Tumors with a Ki-67 proliferation index <55% were less responsive to platinum-based chemotherapy, and patients with such tumors or with well differentiated morphology had better survival than patients who had tumors with poorly differentiated morphology or a higher Ki-67 index. Treatment options beyond platinum-based chemotherapy are emerging. A revision of the World Health Organization high-grade NEC classification seems to be necessary based on recent data. Platinum-based chemotherapy may not be the optimal treatment for patients who have GEP-NEC with a moderately high proliferation rate. Adequate diagnostic and prognostic stratifications constitute the basis for future progress.
Department of Oncology, Haukeland University Hospital, Bergen, Norway.
Halfdan
H
Sorbye
Jonathan
J
Strosberg
Eric
E
Baudin
David S
DS
Klimstra
James C
JC
Yao
D018287:Carcinoma, Large Cell / Q000473:pathology* / Q000628:therapy; D018288:Carcinoma, Small Cell / Q000473:pathology* / Q000628:therapy; D005770:Gastrointestinal Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D060787:Neoplasm Grading; D018358:Neuroendocrine Tumors / Q000473:pathology* / Q000628:therapy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy; D011379:Prognosis
carcinoma; endocrine; gastroenteropancreatic; gastrointestinal; neuroendocrine