title: Prognostic factors in neuroendocrine carcinoma: biological markers are more useful than histomorphological markers.
abstract: Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are a very aggressive type of cancer, for which prognostic factors are lacking. We analysed clinical and histomorphological prognostic markers of overall survival (OS), completed with a record of biological and haematological data of patients diagnosed between December 2002 and December 2015. The median OS was 16 months (95% CI 13.9-18.1). After univariate analysis, performance status (PS) ≥ 2 and stage IV were associated with a worse outcome (9 months and 14 months, respectively), as well as patients with lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels ≥ 2 ULN (9 months and 8 months, respectively). After multivariate analysis, LDH and AST levels were the only factors that remained significantly associated with better survival: HR 0.36 (p = 0.04) and 0.31 (p = 0.03), respectively. When patients had elevated LDH and AST levels, OS was 20 months, when they had high LDH or AST levels, 13 months and 8 months in the group with low LDH and AST levels (p < 0.001). Therefore, biological data appeared to be more relevant prognostic factors than usual factors described in other studies (PS, stage, and Ki-67). Considering LDH and AST levels at diagnosis could help physicians to predict survival and to stratify patients for clinical trials.
authors.affiliation: Hospices Civils de Lyon, Hôpital Edouard Herriot, Service Central d'Anatomie et Cytologie Pathologiques, 69437 Lyon cedex 03, France.|University of Lyon, Université Lyon 1, France.|Equipe Signalisation de l'Immunité Innée et Oncogénèse, Centre de Recherche en Cancérologie de Lyon, UMR Inserm 1052 CNRS 5286, 69373 Lyon cedex 08, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Freis
authors.affiliation: Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Digestive, 69437 Lyon cedex 03, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Graillot
authors.affiliation: Hospices Civils de Lyon, Hôpital Edouard Herriot, Radiologie, 69437 Lyon cedex 03, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Rousset
authors.affiliation: Hospices Civils de Lyon, Hôpital Edouard Herriot, Service Central d'Anatomie et Cytologie Pathologiques, 69437 Lyon cedex 03, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Hervieu
authors.affiliation: Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Biochimie, 69437 Lyon cedex 03, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Chardon
authors.affiliation: Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Digestive, 69437 Lyon cedex 03, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lombard-Bohas
authors.affiliation: University of Lyon, Université Lyon 1, France.|Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Digestive, 69437 Lyon cedex 03, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walter
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor