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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Role of systemic inflammatory factors in gastroenteropancreatic neuroendocrine t...
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Vol. 42. Issue 3.
Pages 156-162 (May - June 2023)
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Vol. 42. Issue 3.
Pages 156-162 (May - June 2023)
Original article
Role of systemic inflammatory factors in gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with peptide receptor radionuclide therapy (PRRT): From biology to theragnosis
Papel de los factores inflamatorios sistémicos en los tumores neuroendocrinos gastroenteropancreáticos (TNE-GEP) tratados con péptidos marcados con radionúclidos (PRRT): de la biología a la teragnosis
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E. Abou-Jokh Casasa, N. Martínez-Lagob, M.C. Mallón Araujoa,
Corresponding author
maramallon@gmail.com

Corresponding author.
, J.M. Cabezas Agrícolac, Z. Nogareda Seoaned, A. Cousillas Castiñeirae, A. Ruibal Morellf, V. Pubul Núñeza
a Department of Nuclear Medicine, Santiago de Compostela University Hospital, Spain
b Department of Oncology, Complexo Hospitalario Universitario A Coruña, Spain
c Department of Endocrinology, Santiago de Compostela University Hospital, Spain
d Department of Nuclear Medicine, Lucus Augusti University Hospital, Spain
e Department of Oncology, Complejo Hospitalario de Pontevedra, Spain
f Professor Emeritus Ad Honorem USC, Santiago de Compostela University Hospital, Spain
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Tables (5)
Table 1. Demographic and baseline clinical characteristics of patients with neuroendocrine tumors.
Table 2. Univariate and multivariate analyses of potential factors contributing to PFS and OS.
Table 3. Baseline systemic inflammation parameters and their impact on PFS and OS.
Table 4. Systemic inflammation parameters after two cycles and their impact on PFS and OS.
Table 5. Number of patients and their behavior of inflammatory indexes between baseline analysis and after the second treatment cycle.
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Abstract
Aim

Systemic inflammatory factors have been validated as indicators of ongoing systemic inflammation that could be predictive markers of poor prognosis for oncological outcomes. However, the prognostic impact of systemic inflammation markers is unknown in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with peptide receptor radionuclide therapy (PRRT).

Methods

We conducted an observational, retrospective, multicentric study of 40 patients with GEP or unknown origin NETs treated with PRRT between 2016 and 2020. The systemic inflammatory markers were calculated as follows: neutrophil to lymphocyte ratio (NLR)=neutrophil count/lymphocyte count, monocyte to lymphocyte ratio (MLR)=monocyte count/lymphocyte count, platelet to lymphocyte ratio (PLR)=platelet count/lymphocyte count, albumin to lymphocyte ratio (ALR)=albumin levels/lymphocyte count and derived Neutrophil to Lymphocyte ratio (dNLR)=neutrophil count/(leucocytes count – neutrophils count). Baseline analysis and after the second dose were used for the calculation of different ratios.

Results

The median age was 63 years (range 41–85), 55% were male. The baseline cut-off values for NLR were 2.61, for MLR 0.31, for PLR 110.14, for ALR 2.39 and for dNLR 1.71. The cut-off values after the 2° dose were, for NLR 2.3, for MLR 0.3, for PLR 131.61, ALR 4.16, and dNLR 1.48. Median progression-free survival (PFS) was 21.7 months (95% CI 10.7–32.8 months) and overall survival (OS) was 32.1 months (95% CI 19.6–44.7 months), PFS was shorter in patients with elevated NLR (p=0.001), ALR (0.03), and dNLR (p=0.001) in baseline analysis. DCR was 81% and ORR 18%.

Conclusions

In GEP or unknown origin NETs treated with PRRT, we have identified the predictive and prognostic impact of baseline systemic inflammatory factors.

Keywords:
Neuroendocrine tumors
Peptide receptor radionuclide therapy (PRRT)
Inflammatory factors
Prognostic factors
Resumen
Objetivo

Los índices inflamatorios sistémicos se han validado como indicadores de inflamación sistémica como marcadores predictivos de mal pronóstico para diversas patologías oncológicas. Sin embargo, se desconoce el impacto pronóstico de los marcadores de inflamación sistémica en pacientes con tumores neuroendocrinos gastroenteropancreáticos (TNE-GEP) tratados con péptidos marcados con radionúclidos (PRRT).

Métodos

Realizamos un estudio observacional, retrospectivo, multicéntrico de 40 pacientes con TNEs-GEP y TNEs de origen desconocido tratados con PRRT entre el 2016 y el 2020. Los marcadores inflamatorios sistémicos se calcularon de la siguiente manera: relación neutrófilos a linfocitos (NLR)=recuento de neutrófilos/recuento de linfocitos, relación de monocitos a linfocitos (MLR)=recuento de monocitos/recuento de linfocitos, relación de plaquetas a linfocitos (PLR)=recuento de plaquetas/recuento de linfocitos, relación de albúmina a linfocitos (ALR)=niveles de albúmina/recuento de linfocitos y relación derivada de neutrófilos a linfocitos (dNLR)=recuento de neutrófilos/(recuento de leucocitos – recuento de neutrófilos). Se utilizaron datos analíticos basales pretratamiento y después de la segunda dosis para el cálculo de los distintos índices.

Resultados

La mediana de edad fue de 63 años (rango 41-85), el 55% eran hombres. Los valores de corte de referencia para NLR fueron 2,61, para MLR 0,31, para PLR 110,14, para ALR 2,39 y para dNLR 1,71. Los valores de corte después de la segunda dosis fueron, para NLR 2,3, para MLR 0,3, para PLR 131,61, ALR 4,16 y dNLR 1,48. La mediana de la sobrevivencia libre de progresión (SLP) fue de 21,7 meses (IC 95%: 10,7-32,8 m) y la supervivencia global (SG) fue de 32,1 meses (IC 95%: 19,6-44,7 m), la SLP fue más corta en pacientes con NLR elevado (p=0,001), ALR (0,03) y dNLR (p=0,001) en el análisis basal. La tasa de control de enfermedad (DCR) fue de 81% y la tasa de respuesta objetiva (ORR) del 18%.

Conclusiones

En los TNE-GEP o de origen desconocido tratados con PRRT hemos identificado el impacto predictivo y pronóstico de los factores inflamatorios sistémicos en la analítica basal pretratamiento.

Palabras clave:
Tumores neuroendocrinos
Terapia con radionúclidos receptores de péptidos (PRRT)
Factores inflamatorios
Factores pronósticos

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