Prediction of Progression-Free Survival in Patients With Advanced, Well-Differentiated, Neuroendocrine Tumors Being Treated With a Somatostatin Analog: The GETNE-TRASGU Study
Por:
Carmona-Bayonas A, Jiménez-Fonseca P, Lamarca Á, Barriuso J, Castaño Á, Benavent M, Alonso V, Riesco-Martínez MDC, Alonso-Gordoa T, Custodio A, Sánchez Cánovas M, Hernando Cubero J, López C, Lacasta A, Fernández Montes A, Marazuela M, Crespo G, Escudero P, Diaz JÁ, Feliciangeli E, Gallego J, Llanos M, Segura Á, Vilardell F, Percovich JC, Grande E, Capdevila J, Valle JW and García-Carbonero R
Publicada:
1 oct 2019
Resumen:
PURPOSE Somatostatin analogs (SSAs) are recommended for the first-line treatment of most patients with well-differentiated, gastroenteropancreatic (GEP) neuroendocrine tumors; however, benefit from treatment is heterogeneous. The aim of the current study was to develop and validate a progression-free survival (PFS) prediction model in SSA-treated patients.
PATIENTS AND METHODS We extracted data from the Spanish Group of Neuroendocrine and Endocrine Tumors Registry (R-GETNE). Patient eligibility criteria included GEP primary, Ki-67 of 20% or less, and first-line SSA monotherapy for advanced disease. An accelerated failure time model was developed to predict PFS, which was represented as a nomogram and an online calculator. The nomogram was externally validated in an independent series of consecutive eligible patients (The Christie NHS Foundation Trust, Manchester, United Kingdom).
RESULTS We recruited 535 patients (R-GETNE, n = 438; Manchester, n = 97). Median PFS and overall survival in the derivation cohort were 28.7 (95% CI, 23.8 to 31.1) and 85.9 months (95% CI, 71.5 to 96.7 months), respectively. Nine covariates significantly associated with PFS were primary tumor location, Ki-67 percentage, neutrophil-to-lymphocyte ratio, alkaline phosphatase, extent of liver involvement, presence of bone and peritoneal metastases, documented progression status, and the presence of symptoms when initiating SSA. The GETNE-TRASGU (Treated With Analog of Somatostatin in Gastroenteropancreatic and Unknown Primary NETs) model demonstrated suitable calibration, as well as fair discrimination ability with a C-index value of 0.714 (95% CI, 0.680 to 0.747) and 0.732 (95% CI, 0.658 to 0.806) in the derivation and validation series, respectively.
CONCLUSION The GETNE-TRASGU evidence-based prognostic tool stratifies patients with GEP neuroendocrine tumors receiving SSA treatment according to their estimated PFS. This nomogram may be useful when stratifying patients with neuroendocrine tumors in future trials. Furthermore, it could be a valuable tool for making treatment decisions in daily clinical practice. (C) 2019 by American Society of Clinical Oncology.
Filiaciones:
Carmona-Bayonas A:
Hospital Universitario Morales Meseguer, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
Jiménez-Fonseca P:
Hospital Universitario Central de Asturias, Oviedo, Spain
Lamarca Á:
The Christie NHS Foundation Trust, Manchester, United Kingdom
Barriuso J:
University of Manchester, Manchester, United Kingdom
The Christie NHS Foundation Trust, Manchester, United Kingdom
Castaño Á:
Hospital Universitario de Fuenlabrada, Madrid, Spain
Benavent M:
Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
Alonso V:
Hospital Universitario Miguel Servet, Zaragoza, Spain
Riesco-Martínez MDC:
Hospital Universitario Doce de Octubre, Madrid, Spain
Alonso-Gordoa T:
Hospital Universitario Ramón Y Cajal, Madrid, Spain
Custodio A:
Hospital Universitario La Paz, Centro de Investigación Biomédica en Red Cáncer, CB16/12/00398, Madrid, Spain
Sánchez Cánovas M:
Hospital Universitario Morales Meseguer, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
Hernando Cubero J:
Hospital Universitario Vall d'Hebron, Vall Hebron Institute of Oncology, Autonomous University of Barcelona, Barcelona, Spain
López C:
Hospital Universitario Marqués de Valdecilla, Santander, Spain
Lacasta A:
Hospital Universitario Donostia, San Sebastián, Spain
Fernández Montes A:
Complexo Hospitalario Universitario de Ourense, Orense, Spain
Marazuela M:
Hospital Universitario de La Princesa, Madrid, Spain
Crespo G:
Complejo Asistencial Universitario de Burgos, Burgos, Spain
Escudero P:
Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
Diaz JÁ:
Hospital Universitario Clínico San Carlos, Madrid, Spain
Feliciangeli E:
Hospital Universitario Santa Lucia, Cartagena, Spain
:
Hospital General Universitario de Elche, Elche, Spain
Llanos M:
Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
Segura Á:
Hospital Universitario La Fe, Valencia, Spain
Vilardell F:
Hospital Universitari Arnau de Vilanova, Lleida, Spain
Percovich JC:
Hospital Universitario Gregorio Marañón, Madrid, Spain
Grande E:
MD Anderson Cancer Center Madrid, Madrid, Spain
Capdevila J:
Hospital Universitario Vall d'Hebron, Vall Hebron Institute of Oncology, Autonomous University of Barcelona, Barcelona, Spain
Valle JW:
The Christie NHS Foundation Trust, Manchester, United Kingdom
University of Manchester, Manchester, United Kingdom
García-Carbonero R:
Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Centro Nacional de Investigaciones Oncológicas, Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
Green Published, hybrid
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