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Molecular prognostic factors in small-intestinal neuroendocrine tumours
K G Samsom1, L M van Veenendaal2, G D Valk3
1Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Background:
Small-intestinal neuroendocrine tumours (SI-NETs) represent a heterogeneous group of rare tumours. In recent years, basic research in SI-NETs has attempted to unravel the molecular events underlying SI-NET tumorigenesis.
Aim:
We aim to provide an overview of the current literature regarding prognostic and predictive molecular factors in patients with SI-NETs.
Method:
A PubMed search was conducted on (epi)genetic prognostic factors in SI-NETs from 2000 until 2019.
Results:
The search yielded 1522 articles of which 20 reviews and 35 original studies were selected for further evaluation. SI-NETs are mutationally quiet tumours with a different genetic make-up compared to pancreatic NETs. Loss of heterozygosity at chromosome 18 is the most frequent genomic aberration (44-100%) followed by mutations of CDKN1B in 8%. Prognostic analyses were performed in 16 studies, of which 8 found a significant (epi)genetic association for survival or progression. Loss of heterozygosity at chromosome 18, gains of chromosome 4, 5, 7, 14 and 20p, copy gain of the SRC gene and low expression of RASSF1A and P16 were associated with poorer survival. In comparison with genetic mutations, epigenetic alterations are significantly more common in SI-NETs and may represent more promising targets in the treatment of SI-NETs.
Conclusion:
SI-NETs are mutationally silent tumours. No biomarkers have been identified yet that can easily be adopted into current clinical decision making. SI-NETs may represent a heterogeneous disease and larger international studies are warranted to translate molecular findings into precision oncology.
Insights
Small-intestinal neuroendocrine tumours (SI-NETs) are genetically quiet. Epigenetic alterations, not genetic mutations, are more common and may offer better therapeutic targets for these rare tumors.
Area of Science:
- Oncology
- Genetics
- Molecular Biology
Background:
- Small-intestinal neuroendocrine tumours (SI-NETs) are rare and heterogeneous.
- Understanding the molecular basis of SI-NET tumorigenesis is crucial.
Purpose of the Study:
- To review prognostic and predictive molecular factors in SI-NETs.
- To identify key genetic and epigenetic alterations associated with SI-NET outcomes.
Main Methods:
- Conducted a PubMed literature search for (epi)genetic prognostic factors in SI-NETs (2000-2019).
- Evaluated 20 reviews and 35 original studies from 1522 initial articles.
Main Results:
- SI-NETs exhibit distinct genetic profiles compared to pancreatic NETs, with loss of heterozygosity at chromosome 18 being frequent.
- Significant associations between specific genomic aberrations (e.g., chromosome 18 LOH, chromosome 4, 5, 7, 14, 20p gains) and poorer survival were identified.
- Epigenetic alterations are more prevalent than genetic mutations in SI-NETs and show promise as therapeutic targets.
Conclusions:
- SI-NETs are characterized by a low mutational burden.
- Currently, no specific biomarkers are readily applicable for clinical decision-making in SI-NETs.
- Further large-scale international studies are needed to translate molecular findings into precision oncology for this heterogeneous disease.
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