NEN incidence increases with age. Elderly population is usually underestimated in clinical trials due to presence of co-morbidities and low performance status (PS) and thus prognosis’ informations are lacking. Our study aims to analyze the outcome in a retrospective cohort of elderly metastatic NEN patients (pts) who underwent different treatments.
From June 2006 to march 2016 we collected data from pts ≥70 y with mNEN. Comorbidities were summarized by the Charlson Comorbidity Index (CCI). Kaplan-Meier method was used to estimate overall survival (OS), Cox’s proportional hazard model to assess the impact of known prognostic factors. Adjusted hazard ratios (HR) were calculated with 95% confidence interval (95% CI).
We identified 145 pts ≥70 y with mNEN. Pts characteristics were resumed in the table. Median follow up was 72.3 (53.2-85.1) months. First Line treatment was: somatostatin analog (SSA) in 79 pts, peptide radionuclide therapy (PRRT) in 23, chemotherapy (CHT) in 36 pts. Seven pts didn’t receive first line treatment and 102 pts received more than 1 line treatment. PS ECOG and FDG PET results were identified as independent prognostic factors for OS assessed by a multivariate Cox regression model, with a higher risk for patients with PS ECOG ≥0 and with positive FDG PET, while age at diagnosis showed a hazard ratio of 1.10 (95%CI:0.99-1.26). Median OS was 5.1y (3.4-6.6). No difference in mOS were seen according to CCI. G1/G2 NEN pts who underwent PRRT as first line had a mOS of 6.5 y (3.3-NE), SSA 5.7 y (4.2-7) and CHT 5.9 y (0.4-NE) respectevely. G3NEN pts treated with CHT had a mOS of 1.5 y (1.0-2.5).Table:
|Pts characteristics||N (%)|
|Age at diagnosis|
|Median (range)||74 (70-87)|
|70-74 years||89 (61.4)|
|75-79 years||40 (27.6)|
|80+ years||16 (11.0)|
Our results suggest a positive impact of various treatment on OS in mNEN elderly patients and the prognostic value of FDG PET and PS ECOG. Prospective clinical trial are needed to confirm our retrospective data.
Clinical trial identification
Legal entity responsible for the study
Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS
All authors have declared no conflicts of interest.