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Critical updates in neuroendocrine tumors: Version 9 American Joint Committee on Cancer staging system for gastroenteropancreatic neuroendocrine tumors. ​

文献信息 ​

DOI10.3322/caac.21840
PMID38685134
期刊CA: a cancer journal for clinicians
影响因子232.4
JCR 分区Q1
发表年份2024
被引次数19
关键词美国联合癌症委员会（AJCC）第9版，癌症分期协议，胃肠胰神经内分泌肿瘤，胃肠神经内分泌肿瘤，胰腺神经内分泌肿瘤
文献类型Journal Article, Review
ISSN0007-9235
页码359-367
期号74(4)
作者Aman Chauhan, Kelley Chan, Thorvardur R Halfdanarson, Andrew M Bellizzi, Guido Rindi, Dermot O'Toole, Phillip S Ge, Dhanpat Jain, Arvind Dasari, Daniel A Anaya, Emily Bergsland, Erik Mittra, Alice C Wei, Thomas A Hope, Ayse T Kendi, Samantha M Thomas, Sherlonda Flem, James Brierley, Elliot A Asare, Kay Washington, Chanjuan Shi

一句话小结 ​

美国癌症联合委员会（AJCC）更新了胃肠胰神经内分泌肿瘤（GEP-NETs）的分期系统，反映了近年来在诊断和治疗技术方面的重要进展，包括对血清嗜铬粒蛋白A的诊断和监测的反对以及内窥镜技术的认可。该研究的意义在于优化肿瘤分期定义，提升GEP-NETs的管理效率，以便更好地指导临床实践。

在麦伴科研 (maltsci.com) 搜索更多文献 ​

美国联合癌症委员会（AJCC）第9版 · 癌症分期协议 · 胃肠胰神经内分泌肿瘤 · 胃肠神经内分泌肿瘤 · 胰腺神经内分泌肿瘤

摘要 ​

美国癌症联合委员会（AJCC）针对所有癌症部位的分期系统，包括胃肠胰神经内分泌肿瘤（GEP-NETs），旨在动态更新，以优化AJCC分期定义。这需要专家的合作，以评估支持对各分期系统进行更改的新证据。GEP-NETs是仅次于结直肠癌的第二大来源于胃肠道的肿瘤。自AJCC第八版发布以来，世界卫生组织对分类进行了更新，将3级GEP-NETs与分化差的神经内分泌癌分开。此外，由于在GEP-NETs的诊断和治疗技术方面的重大进展，AJCC第九版反对使用血清嗜铬粒蛋白A进行GEP-NETs的诊断和监测。此外，AJCC第九版还承认内窥镜及内窥镜切除在NETs，尤其是在胃、十二指肠和结直肠的诊断和管理中的重要作用。最后，T1NXM0被添加到这些疾病部位的I期和阑尾的I期中。

英文摘要 ​

The American Joint Committee on Cancer (AJCC) staging system for all cancer sites, including gastroenteropancreatic neuroendocrine tumors (GEP-NETs), is meant to be dynamic, requiring periodic updates to optimize AJCC staging definitions. This entails the collaboration of experts charged with evaluating new evidence that supports changes to each staging system. GEP-NETs are the second most prevalent neoplasm of gastrointestinal origin after colorectal cancer. Since publication of the AJCC eighth edition, the World Health Organization has updated the classification and separates grade 3 GEP-NETs from poorly differentiated neuroendocrine carcinoma. In addition, because of major advancements in diagnostic and therapeutic technologies for GEP-NETs, AJCC version 9 advocates against the use of serum chromogranin A for the diagnosis and monitoring of GEP-NETs. Furthermore, AJCC version 9 recognizes the increasing role of endoscopy and endoscopic resection in the diagnosis and management of NETs, particularly in the stomach, duodenum, and colorectum. Finally, T1NXM0 has been added to stage I in these disease sites as well as in the appendix.

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主要研究问题 ​

  1. GEP-NETs的最新分级标准与之前版本相比，有哪些具体的变化和影响？
  2. 在AJCC第九版中，为什么不再推荐使用血清嗜铬粒蛋白A进行GEP-NETs的诊断和监测？
  3. 近年来，内窥镜技术在GEP-NETs的诊断和管理中发挥了怎样的作用？
  4. 影响GEP-NETs分期系统更新的主要证据和研究是什么？
  5. 如何评估AJCC第九版分期系统对GEP-NETs患者预后的影响？

核心洞察 ​

研究背景和目的 ​

美国癌症联合委员会（AJCC）癌症分期系统旨在动态更新，以优化各癌症类型的分期定义。特别是针对胃肠胰神经内分泌肿瘤（GEP-NETs），这一肿瘤是继结直肠癌之后的第二大消化道起源肿瘤。研究的主要目的是评估新证据，并对AJCC分期系统进行必要的修订，以反映最新的分类和诊断技术进展。

主要方法/材料/实验设计 ​

研究主要通过文献回顾和专家共识的方法，评估AJCC分期系统的更新需求，尤其是针对GEP-NETs的相关变更。以下是技术路线的流程图：

Mermaid diagram

关键结果和发现 ​

  1. 分级更新：世界卫生组织已更新分类，将GEP-NETs的3级肿瘤与分化差的神经内分泌癌分开。
  2. 生物标志物使用：AJCC第九版反对使用血清嗜铬粒蛋白A作为GEP-NETs的诊断和监测工具。
  3. 内镜技术的角色：AJCC第九版认可内镜及内镜切除在NETs（特别是胃、十二指肠和结肠）诊断和管理中的重要性。
  4. 新分期：在这些病变部位，T1NXM0被纳入第I期分期。

主要结论/意义/创新性 ​

AJCC第九版的更新反映了对GEP-NETs最新研究成果和技术进展的响应，尤其是在肿瘤分类、诊断手段和治疗策略方面的变化。这一更新不仅提升了分期系统的科学性和实用性，也为临床医生提供了更为准确的工具，以指导患者的管理和治疗。

研究局限性和未来方向 ​

  • 局限性：当前更新主要基于专家共识和已有文献，缺乏大规模前瞻性研究的支持，可能影响其广泛适用性。
  • 未来方向：建议开展多中心的前瞻性研究，以验证AJCC第九版的有效性，并进一步探索新的生物标志物和诊断技术在GEP-NETs管理中的应用。

参考文献 ​

  1. Enterochromaffin-like Cell Hyperplasia-Associated Gastric Neuroendocrine Tumors May Arise in the Setting of Proton Pump Inhibitor Use. - Rehan Rais;Nikolaos A Trikalinos;Jingxia Liu;Deyali Chatterjee - Archives of pathology & laboratory medicine (2022)
  2. Morphological Factors Related to Nodal Metastases in Neuroendocrine Tumors of the Appendix: A Multicentric Retrospective Study. - Nicole Brighi;Stefano La Rosa;Giulio Rossi;Federica Grillo;Sara Pusceddu;Maria Rinzivillo;Francesca Spada;Salvatore Tafuto;Sara Massironi;Antongiulio Faggiano;Lorenzo Antonuzzo;Donatella Santini;Fausto Sessa;Roberta Maragliano;Fabio Gelsomino;Manuela Albertelli;Claudio Vernieri;Francesco Panzuto;Nicola Fazio;Chiara De Divitiis;Giuseppe Lamberti;Annamaria Colao;Gianfranco Delle Fave;Davide Campana - Annals of surgery (2020)
  3. Chromogranin A as circulating marker for diagnosis and management of neuroendocrine neoplasms: more flaws than fame. - Vincenzo Marotta;Maria Chiara Zatelli;Concetta Sciammarella;Maria Rosaria Ambrosio;Marta Bondanelli;Annamaria Colao;Antongiulio Faggiano - Endocrine-related cancer (2018)
  4. Expanding Role of Gastroenterology in the Staging of Digestive Neuroendocrine Tumors: Updates From the American Joint Committee on Cancer Version 9 Cancer Staging System. - Phillip S Ge;Chanjuan Shi;Elliot Asare;Mary Kay Washington;Dermot O'Toole; - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2024)
  5. The epidemiology of gastroenteropancreatic neuroendocrine tumors. - Ben Lawrence;Bjorn I Gustafsson;Anthony Chan;Bernhard Svejda;Mark Kidd;Irvin M Modlin - Endocrinology and metabolism clinics of North America (2011)
  6. Epidemiology of Gastric Malignancies 2000-2018 According to Histology: A Population-Based Analysis of Incidence and Temporal Trends. - Sheila D Rustgi;Meg McKinley;Brandon McBay;Haley M Zylberberg;Scarlett L Gomez;Chin Hur;Fay Kastrinos;Samir Gupta;Michelle Kang Kim;Steven H Itzkowitz;Shailja C Shah - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2023)
  7. The Distal Predilection of Small Bowel Neuroendocrine Tumors. - Kendall J Keck;Jessica E Maxwell;Alan F Utria;Andrew M Bellizzi;Joseph S Dillon;Thomas M O'Dorisio;James R Howe - Annals of surgical oncology (2018)
  8. Survival and Incidence Patterns of Pancreatic Neuroendocrine Tumors Over the Last 2 Decades: A SEER Database Analysis. - Mohamad Bassam Sonbol;Gina L Mazza;Lanyu Mi;Thomas Oliver;Jason Starr;Hallbera Gudmundsdottir;Sean P Cleary;Timothy Hobday;Thorvardur R Halfdanarson - The oncologist (2022)
  9. Consensus report of the 2021 National Cancer Institute neuroendocrine tumor clinical trials planning meeting. - Simron Singh;Thomas A Hope;Emily B Bergsland;Lisa Bodei;David L Bushnell;Jennifer A Chan;Beth R Chasen;Aman Chauhan;Satya Das;Arvind Dasari;Jaydira Del Rivero;Ghassan El-Haddad;Karyn A Goodman;Daniel M Halperin;Mark A Lewis;O Wolf Lindwasser;Sten Myrehaug;Nitya P Raj;Diane L Reidy-Lagunes;Heloisa P Soares;Jonathan R Strosberg;Elise C Kohn;Pamela L Kunz; - Journal of the National Cancer Institute (2023)
  10. Head-to-Head Comparison of 64Cu-DOTATATE and 68Ga-DOTATOC PET/CT: A Prospective Study of 59 Patients with Neuroendocrine Tumors. - Camilla B Johnbeck;Ulrich Knigge;Annika Loft;Anne K Berthelsen;Jann Mortensen;Peter Oturai;Seppo W Langer;Dennis R Elema;Andreas Kjaer - Journal of nuclear medicine : official publication, Society of Nuclear Medicine (2017)

引用本文的文献 ​

  1. AJCC Cancer Staging System Version 9: Practice-Informing Updates for Gastroenteropancreatic Neuroendocrine Tumors. - Kelley Chan;Aman Chauhan;Chanjuan Shi - Annals of surgical oncology (2024)
  2. Pathological Features Associated with Lymph Node Disease in Patients with Appendiceal Neuroendocrine Tumors. - Salvador Rodriguez Franco;Sumaya Abdul Ghaffar;Ying Jin;Reed Weiss;Mona Hamermesh;Andrii Khomiak;Toshitaka Sugawara;Oskar Franklin;Alexis D Leal;Christopher H Lieu;Richard D Schulick;Marco Del Chiaro;Steven Ahrendt;Martin D McCarter;Ana L Gleisner - Cancers (2024)
  3. Pancreatic Neuroendocrine Neoplasms: Classification and Novel Role of Endoscopic Ultrasound in Diagnosis and Treatment Personalization. - Matteo Tacelli;Stefano Partelli;Massimo Falconi;Paolo Giorgio Arcidiacono;Gabriele Capurso - United European gastroenterology journal (2025)
  4. NON-FUNCTIONING SPORADIC PANCREATIC NEUROENDOCRINE TUMOR IS AN INDEPENDENT RISK FACTOR FOR RECURRENCE AFTER SURGICAL TREATMENT. - Estela Regina Ramos Figueira;André Luis Montagnini;Jessica Okubo;Ana Gabriela Vivarelli Fernandes;Marina Alessandra Pereira;Ulysses Ribeiro Junior;Paulo Herman;José Jukemura - Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery (2025)
  5. Development and validation of predictive models for distant metastasis and prognosis of gastroenteropancreatic neuroendocrine neoplasms. - Xuan-Peng Zhou;Luan-Biao Sun;Wen-Hao Liu;Xin-Yuan Song;Yang Gao;Jian-Peng Xing;Shuo-Hui Gao - Scientific reports (2025)
  6. Duodenal neuroendocrine tumours masquerading as peptic duodenitis, crushed lymphoid aggregates and prominent Brunner glands: some diagnostic pitfalls. - Lena Hasson;Dipti M Karamchandani - Histopathology (2025)
  7. Clinicopathological Correlates of Hormone Expression-Based Subtypes of Non-Functioning Duodenal/Ampullary Neuroendocrine Tumors: A Multicenter Study of 151 Cases. - Alessandro Vanoli;Nestor Piva;Frediano Socrate Inzani;Federica Grillo;Catherine Klersy;Silvia Uccella;Paola Spaggiari;Luca Albarello;Marco Schiavo Lena;Massimo Milione;Caterina Antoniacomi;Anna Caterina Milanetto;Alessandro Zerbi;Antonio Di Sabatino;Massimo Falconi;Andrea Anderloni;Paola Mattiolo;Claudio Luchini;Aldo Scarpa;Matteo Fassan;Paola Parente;Ombretta Luinetti;Guido Rindi;Marco Paulli;Stefano La Rosa - Endocrine pathology (2025)
  8. Machine learning predicts prognosis in patients with gastroenteropancreatic neuroendocrine tumors with liver metastases. - Fuli Gao;Jian Chen;Xiaodan Xu - Discover oncology (2025)
  9. Metabolic changes in neuroendocrine neoplasms. - Chunhua Hu;Lingyi Chen;Yi Ding;Mujie Ye;Qiyun Tang - Cellular and molecular life sciences : CMLS (2025)
  10. Prognosis of NETs: Has There Been Improvement over the Last 30 Years? - Dominique Clement;Debashis Sarker;Aviva Frydman;Andrzej Rak;Vina Soran;David C Llewellyn;Raj Srirajaskanthan - Neuroendocrinology (2025)

... (9 更多 篇文献)

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