Occurrence of exocrine pancreatic insufficiency in patients with advanced neuroendocrine tumors treated with somatostatin analogs |
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| Affiliation: | 1. Digestive Disease Unit, Sant’Andrea University Hospital, ENETS Center of Excellence, Italy;2. Dept. of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Italy;1. Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan;2. Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery and Organ Transplantation, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan;1. Digestive and Mini-invasive Surgery unit, Department of Digestive Surgery and Transplantation, St Eloi Hospital, centre hospitalier universitaire, 80, avenue Augustin-Fliche, 34295 Montpellier, France;2. Université de Montpellier-Nîmes, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France;3. Department of Medical Oncology, université de Montpellier-Nîmes, centre hospitalier universitaire, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France;4. Department of Digestive Surgery, University of Montpellier-Nîmes, Carémeau Hospital, place du professeur Debré, 30900 Nîmes, France;5. Department of Endocrinology, université de Montpellier-Nîmes, centre hospitalier universitaire, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France;6. Department of Radiology, université de Montpellier-Nîmes, centre hospitalier universitaire, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France;7. Department of Gastroenterology, University of Montpellier-Nîmes, Carémeau Hospital, place du professeur Debré, 30900 Nîmes, France;8. Oncology, université de Montpellier-Nîmes, institut du cancer de Montpellier (ICM), parc Euromédecine, 208, rue des Apothicaires, 34298 Montpellier, France;9. Department of Pathology, université de Montpellier-Nîmes, centre hospitalier universitaire, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France;10. Digestive & Oncologic Surgery, université de Montpellier-Nîmes, institut du cancer de Montpellier (ICM), parc Euromédecine, 208, rue des Apothicaires, 34298 Montpellier, France;1. National and Kapodistrian University of Athens, Athens, Greece;2. Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden;3. University of Oxford, Oxford, UK;4. Green Templeton College, Oxford, UK;5. Royal Free London, London, UK;6. Barts and the London School of Medicine, London, UK;7. EKPA-LAIKO ENETS Center of Excellence, Athens, Greece;1. Digestive Disease Unit, Sant’Andrea University Hospital, ENETS Center of Excellence, Rome, Italy;2. Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, ENET Center of Excellence, Milan, Italy;3. Endocrinology Unit, Dept. of Experimental Medicine, Sapienza University of Rome, Italy;4. NET Team Bologna ENETS Center of Excellence, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Italy;5. Naples ENETS Center of Excellence, Oncology, Cardarelli Hospital, Naples, Italy;6. Radiology, Sant’Andrea University Hospital, ENETS Center of Excellence, Rome, Italy;7. Naples ENETS Center of Excellence, Department of Abdominal Oncology, Istituto Nazionale, Tumori di Napoli “G. Pascale” IRCCS, National Cancer Institute, Naples, Italy;8. Naples ENETS Center of Excellence, Oncology Unit, AO dei Colli, Monaldi Unit, Naples, Italy;9. Digestive Disease Unit, Sant’Andrea University Hospital, Dept. of Medical-Surgical Sciences and Translatioal Medicine, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy;10. NET Team Bologna ENETS Center of Excellence, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Italy;1. University of Colorado Anschutz Medical Center, Aurora, CO, United States;2. Mayo Clinic, Rochester, MN, United States;3. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, United States;4. University of Pittsburgh Medical Center, Pittsburgh, PA, United States |
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| Abstract: | BackgroundAlthough exocrine pancreatic insufficiency (EPI) has been described in patients with neuroendocrine neoplasia (NEN) treated with somatostatin analogs (SSAs), its role in the therapeutic management of these patients is not well established.AimTo determine the frequency of EPI in patients with NEN long-term treated with SSAs.MethodsThis is a prospective single-center study evaluating 35 patients treated with SSAs for >12 months due to unresectable/advanced nonpancreatic well-differentiated NEN. Clinical evaluation, biochemical parameters, and fecal elastases 1 (FE-1) were assessed to diagnose EPI.ResultsA total of 7 patients (20%) had EPI, given the presence of abdominal symptoms and a median FE-1 value of 180 mcg/g stool (150–198). No patient had severe EPI, defined as FE-1 < 100 mcg/g stool. Elevated glycated Hb levels were a significant predictor for developing EPI (OR 4.81, p = 0.01). No significant difference in terms of duration of SSA treatment was observed between patients with or without EPI diagnosed (84 months and 72 months, respectively; p = 0.950).ConclusionsMild-moderate EPI is a relatively common condition in patients receiving long-term treatment with SSAs. Specific clinical and biochemical evaluations, including FE-1, should be planned in these patients to diagnose this relevant condition early, which may deteriorate quality of life and cause malnutrition. |
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| Keywords: | Neuroendocrine tumors Exocrine pancreatic insufficiency Somatostatin analog Malnutrition Pancreatic enzymes |
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