Metastatik gastroenteropankreatik nöroendokrin karsinomlarda (GEP-NEC) sistemik tedavi yanıtlarının ve prognostik faktörlerin araştırılması

Year 2025, Volume: 8 Issue: 6, 959 - 965, 25.10.2025

Alper Türkel , Duygu Ercan Uzundal , Fatih Gürler , İlknur Deliktaş Onur , Serkan Gülcü , Ülkü Yalçıntaş Arslan

Abstract

Giriş: Bu çalışmada, metastatik gastroenteropankreatik nöroendokrin karsinom (GEP-NEC) tanılı hastalarda, birinci ve ikinci basamak tedavilere yanıtlar, sağkalım sonuçları ve sağkalımı etkileyen potansiyel faktörlerin değerlendirilmesi amaçlanmıştır.
Yöntem: Bu retrospektif çalışmaya üç merkezden metastatik GEP-NEC'li 42 hasta dahil edilmiştir. Birinci ve ikinci basamak kemoterapi rejimleri incelenmiştir. Birinci ve ikinci basamak tedaviler için ortanca progresyonsuz sağkalım (mPFS1 ve mPFS2) ve genel sağkalım (mOS) değerlendirilmiştir. CRP düzeyleri, LDH düzeyleri, nötrofil-lenfosit oranı (NLR) ve trombosit-lenfosit oranının (PLR) sağkalım üzerindeki etkileri olası prognostik faktörler olarak araştırılmıştır.
Bulgular: Ortanca takip süresi 15 ay (3-113) olarak saptandı. mPFS1 5 ay (95% CI: 2,88-7,11) ve mPFS2 2 ay (95% CI: 1,67-2,32) idi. mOS 15 ay idi (95% CI: 10,90-19,09). Küratif amaçlı cerrahi yapılan hastaların mOS'si 28 ay iken, opere edilemeyen hastaların mOS'si 14 ay idi (p = 0,010). NLR < 2,56 olan hastaların mOS'si, NLR ≥ 2,56 olanlara göre daha uzundu (22 ay - 14 ay, p = 0,019). Çok değişkenli analiz, daha düşük NLR skorları ve Ki67 değerlerinin daha uzun mOS ile ilişkili olduğunu göstermiştir [HR: 0,38 (95% CI: 0,18-0,79), p = 0,010 ve HR: 0,41 (95% CI: 0,20-0,84), p = 0,015].
Sonuç: Çalışmamız, daha yüksek NLR skorları ve Ki67 değerlerinin mOS'yi önemli ölçüde kötüleştirdiğini göstermiştir. Sağkalım sonuçları (OS, PFS1 ve PFS2) mevcut literatürle uyumluydu. Kötü prognozları, kısa sağkalım süreleri ve standart tedavi önerilerinin eksikliği nedeniyle nöroendokrin karsinomlarda yeni tedavi seçenekleri ve prognostik belirteçlere ihtiyaç vardır.

Keywords

Ekstrapulmoner , Nöroendokrin karsinom , GEP-NEC , NLR

Investigation of systemic treatment responses and prognostic factors in metastatic gastroenteropancreatic neuroendocrine carcinomas (GEP-NECs)

Abstract

Aims: This study aimed to evaluate responses to first- and second-line treatments, survival outcomes, and potential factors affecting survival in patients with metastatic gastroenteropancreatic neuroendocrine carcinoma (GEP-NEC).
Methods: This retrospective study included 42 patients with metastatic GEP-NEC from three centers. First and second-line chemotherapy regimens were examined. The median progression-free survival (mPFS1 and mPFS2) for first and second-line treatments and overall survival (mOS) were evaluated. The effects of CRP levels, LDH levels, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) on survival were investigated as potential prognostic factors.
Results: Median follow-up was 15 months (3-113). mPFS1 was 5 months (95% CI: 2.88-7.11) and mPFS2 was 2 months (95% CI: 1.67-2.32). The mOS was 15 months (95% CI: 10.90-19.09). Curative surgery patients had a 28-month mOS, and patients who could not undergo surgery had a mOS of 14 months (p=0.010). Patients with NLR <2.56 had a longer mOS (22 months vs. 14 months, p=0.019) than those with NLR ≥2.56. Multivariate analysis showed that lower NLR scores and Ki67 values were associated with longer mOS [HR: 0.38 (95% CI: 0.18-0.79), p=0.010 and HR: 0.41 (95% CI: 0.20-0.84), p=0.015]
Conclusion: Our study showed that higher NLR scores and Ki67 values significantly worsened mOS. Survival outcomes (OS, PFS1, and PFS2) aligned with the literature. NECs need new treatments and prognostic markers due to their poor prognosis, short survival times, and lack of standard guidelines.

Keywords

Extrapulmonary , neuroendocrine carcinoma , GEP-NEC , NLR

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