disclosure of relevant financial relationships · 2017-01-23 · disclosure of relevant financial...
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Disclosure of Relevant Financial Relationships
USCAP requires that all faculty in a position to
influence or control the content of CME disclose any relevant financial
relationship WITH COMMERCIAL INTERESTS which they or their
spouse/partner have, or have had, within the past 12 months, which relates to
the content of this educational activity and creates a conflict of interest.
Dr. Stefano La Rosa declares he has no conflict(s) of interest to disclose
Grading
G1
G2
G3
Mitoses
m<2
2< m <20
m >20
Ki67 index
Ki67<3%
3%< Ki67<20%
Ki67 >20%
G1
G2
G3
D. Klimstra
P. Komminoth
S. La Rosa
V. Adsay
G. Klöppel
2017
GEP neuroendocrine neoplasms are a heterogeneous group of neoplastic proliferations characterized by specific clinico-pathological and molecular features which mainly depend on the site of origin
Take home message: Ki67 labeling index is a good prognostic marker but it should not be used alone to stratify patients in different prognostic categories; it should be considered together with clinico-pathologic tumor type and stage
• Ki-67: <2.5% (140 cases), 2.5-20% (31 cases)
• Mitoses: <2 (140 cases), 2-20 (16 cases)
• Grade: G1 (80%), G2 (20%)
• No WD-NET with Ki67>20%
• Morphology: well differentiated (176 cases)
Differences among NET subtypes
G1 G2
92% 8%
85% 15%
65% 35%
82% 18%
GP
Gatrinoma
D-cell tumor
NF- NET
Predictors of lymph node involvement
Proliferative grading, lymphovascular invasion and level of wall invasion can effectively predict LN metastases
Size, proliferative grade 2 and 3, lymphovascular invasion, wall invasion and stage III-IV are significantly related to worse survival.
Disease specific survival
Take home message:
•Ki67 labeling index is not useful to separate different tumor categories •Ki67 labeling index is a predictor of lymph node involvement •Although Ki67 labeling index is a predictor of disease free survival when considering duodenal NENs all together (G1, G2, G3), it does not discriminate alone the disease free survival between G1 and G2.
Take home message
Most ileal NETs are G1 and metastatic However: Ki67 is an independent predictor for tumor
progression 14% increased risk for tumor progression for each
increasing unit Ki67 is an independent risk factor for decreased
survival Ki67 cut-off at 5% seems better to discriminate
between G1 and G2
Take home message: For appendiceal NETs reporting tumor grade is
recommended by guidelines However, tumor grade is not statistically correlated with a
different survival, which mainly depends on stage
Reference Jernman 2012 Hong 2013 Tsukamoto 2008 Kim 2013 Sohn 2015 Li 2015 Nakamura 2016
Total
N°
72 37 23 79
972 147 170
1500
G1
61 33 17 79
906 137 166
1399 (93.2%)
G2
11 4 6 0
66 10 4
101 (6.8%)
Ki67 has been generally used for grading evaluation because
mitoses are extremely rare
Sohn et al. Cancer Res Treat 47:813, 2015
Take home message: Most rectal NETs are G1 Ki67 index is a prognostic marker The recently proposed cut-off of 3% seems the best one Ki67 index should not be used alone as a prognosticator, but in association
with tumor size, lympho-vascular invasion, level of wall infiltration, and immunophenotype (L-cell versus EC-cell)
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The value and pitfalls of Ki67 labeling index in gastrointestinal neuroendocrine
neoplasms
The value and pitfalls of Ki67 labeling index in gastrointestinal neuroendocrine
neoplasms
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