Abstract 4484
Background
Treatment with somatostatin analogs (SSA) in monotherapy is the most attractive first-line option for most patients with well-differentiated stage IV unresectable gastroenteropancreatic neuroendocrine tumors (GEP-NETs). The objective is to develop and internally validate tool for predicting progression-free survival (PFS) during treatment with SSA.
Methods
The GETNE-TRASGU study is a subanalysis of the Spanish Group of NETs registry (R-GETNE). The cohort contains 309 patients treated between 2000-2017 with SSA in the first-line of advanced disease. PFS data were evaluated using Cox proportional risk regression and graphically represented as a nomogram. Missing data were controlled by multiple imputation. Bootstrap Harrell's c-index with 150 replications was used to assess discrimination.
Results
The median PFS was 25.5 months (95% CI, 20.8-30.8). The nomogram contains 5 covariates significantly associated with PFS: Ki67% index, neutrophil-lymphocyte ratio (NLR), extrahepatic metastases, liver tumor burden and primary tumor location. The median PFS was 3.7 (95% CI, 2.5-not computable) in poor prognosis group, 8.3 (95% CI, 6.0-30.0) in intermediate-bad, 18.4 (95% CI, 14.3-23.6) in intermediate-good, and 37.1 months (95% CI, 30.8-53.5) in good prognosis group. Ki67% (continuous variable) predicted PFS with HR 1.03 (95% CI, 1.01-1.06), RNL (continuous variable) with HR 1.08 (95%CI, 1.01-1.16), extrahepatic metastases with HR 1.70 (I95% CI 1.23-2.32), liver tumor burden >50% with HR 2.07 (95% CI, 1.28-3.34); compared with intestinal (reference), pancreatic with HR 2.18 (95%CI, 1.56-3.04), rectal with HR 1.99 (95% CI, 1.11-3.58), unknown origin with HR 1.71 (95% CI, 1.02-2.85), and other tumors with HR 2.58 (95% CI, 1.22-5.43). This model shows adequate calibration, with acceptable discrimination capability [c-index of 0.641 (95% CI, 0.60-0.68)].
Conclusions
The GETNE-TRASGU nomogram allows stratification of patients with advanced and well-differentiated GEP-NETs into four prognostic groups, with potential implications for treatment selection.
Clinical trial identification
Legal entity responsible for the study
Grupo Español de Tumores Endocrinos y Neuroendocrinos (GETNE).
Funding
Grupo Español de Tumores Endocrinos y Neuroendocrinos (GETNE).
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
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