Neuroendocrine Neoplasm in China​—Present and Future - Min-Hu Chen, MD, PhD - Jie Chen, MD, PhD

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9 WORLD GASTROENTEROLOGY NEWS MAY 2016 Editorial | Expert Point of View | Gastro 2016: EGHS-WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events Neuroendocrine Neoplasm in China​ —Present and Future Neuroendocrine neoplasms (NEN) are a group of heterogeneous tumors arising from amine precursor uptake decarboxylation neuroendocrine cells. Epidemiological data according to the National Cancer Institute of United States (NCI), the National Cancer Registry of Spain (RGETNE), the Norwegian Registry of Cancer, and the nationwide Swedish Family-Can-cer Database have shown that the in-cidence of NEN in western countries was 2.5-5/100,000 1-4. Over the past three decades, the incidence of NEN has significantly increased five-fold from 1.09/100,000 to 5.25/100,000. Contrasted with other tumors, the incidence of NEN increased more rapidly, which may due to the im-provement of diagnostic precision, the increased awareness of NEN by clini-cians, more frequent screening for tu-mors, and other environmental factors 1, 3. There are still no epidemiological data of NEN based on population in mainland China. However, an in-vestigation from Taiwan showed that the incidence of NEN also increased five-fold from 0.3/100,000 in 1996 to 1.5/100,000 in 2008 5. Gastroenteropancreatic Neuroen-docrine Neoplasm (GEP-NEN) is the most common type of NEN, account-ing for 65%-75% of NEN from all sites 6, 7. However, among different ethnicities and regions, the primary sites are different. In the Asian- Pacific region, the top three sites of GEP-NEN are rectum, pancreas, and stomach, while small intestinal NEN is much rarer 5. A multi-center retrospective pathological study in mainland China also indicates pan-creas and rectum as the most common sites (data not yet published). Since NEN can originate from any site throughout the body, and its clini-cal manifestations are so complex and diverse, accurate diagnosis of NEN is more complicated and more special-ized than that of other tumors. The diagnostic method of NEN should be comprehensive, analyzing the results of serology, imaging, endos-copy, nuclear medicine, and pathol-ogy. Otherwise, treatment of NEN patients should be individualized with multidisciplinary comprehensive management, including procedures (endoscopy and surgery), interven-tional therapy and nuclide therapy, chemotherapy, biotherapy and mo-lecular target therapy, etc. Compared to other tumors, more specialized departments should be involved in the diagnosis and treatment of NEN. In mainland China, most of the physicians lack a thorough under-standing of NEN and they often refer these patients to different depart-ments. NEN patients were handled respectively by each specialized de-partment before 2010. Chinese doc-tors started to pay attention to these rare tumors in 2010 when the nomen-clature and classification of neuroen-docrine tumors of digestive system were updated by the World Health Organization (WHO) 8. Thereafter, pathologists in China successively reached two consensuses on patho-logical diagnosis of GEP-NEN which were published in 2011 and 2013 respectively 9, 10. In clinical practice, some large medical centers succes-sively started to set up neuroendocrine neoplasm multi-disciplinary teams (NEN-MDT). Various professional societies/studies (including the disci-plines of gastroenterology, oncology, and pancreatic surgery) have released several related guidelines/consensuses for NEN respectively 11-13. However, few of these guidelines/consensuses reference clinical studies based on the Chinese population. By search-ing on the PubMed, we found that Chinese researchers have published 89 total articles on GEP-NEN in international journals between 2010 and 2015. However, 51 of them are small-scale single institution clinical Min-Hu Chen, MD, PhD Professor of Medicine and Consultant Gastroenterologist Department of Gastroenterology The First Affiliated Hospital, Sun Yat-sen University President-elect, Chinese Association of Gastroenterology Guangzhou, P.R. China Jie Chen, MD, PhD Professor of Medicine and Consultant Gastroenterologist Department of Gastroenterology The First Affiliated Hospital, Sun Yat-Sen University Chair of the Chinese Study Group for Neuroendocrine Tumors Guangzhou, P.R. China


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