Проблема пересмотра классификации нейроэндокринных опухолей (НЭО) желудочно-кишечного тракта (ЖКТ), поджелудочной железы (ПЖ) и легкого на основе новых подходов к определению степени их злокачественности (Grade) становится все более актуальной. Все эти опухоли отличаются как по клиническому течению, так и по ответу на разные схемы терапии.
11-я Ежегодная конференция Европейского общества по изучению НЭО (ENETS), которая состоялась 5–7 марта 2014 г.
в Барселоне (Испания), была посвящена вопросу выбора новых пороговых значений митотического индекса и индекса Ki-67 для внесения изменений в систему градаций НЭО ЖКТ и ПЖ и разделения на этом основании прежних групп G2 и G3 на подгруппы. Кроме того, было предложено унифицировать терминологию для НЭО легких и ЖКТ, а также разделить НЭО легких на группы G1, G2 и G3 с соответствующими для опухолей этой локализации пороговыми значениями митотического индекса и индекса Ki-67.
The revision of the classification of neuroendocrine tumors (NETs), such as gastrointestinal (GI), pancreatic (PETs) and lungs tumors, according to the new approaches to determine the tumor grade (Grade) is becoming increasingly important. All these tumors differ according to the clinical course and response to different therapeutic regimens. 11-th annual European Neuroendocrine Tumor Society Conference (ENETS), which took place on 5–7 March 2014 in Barcelona (Spain), had been devoted to the choice of new thresholds of mitotic index and Ki-67 proliferation index to make changes in the gradation system of GI NETs and PETs and to divide the previous groups G2 and G3 into the subunits. Besides, it was suggested to unify the lung and GI NETs terminology and to divide lung NETs in to the G1, G2 and G3 groups, according to the threshold levels of mitotic index and Ki-67 proliferation index, concerning the localization of these tumors.
Key words: neuroendocrine tumors, gastrointestinal tract, lungs, new gradation, revision of the classification.
1. Bosman FT, Carneiro FT, Hrubon RH et al. (Eds) World Health Organization Classification of Tumours, Pathology and Genetics of Tumours of the Digestive System. IARC Press: Lyon, France, 2010.
2. McCall C, Shi C, Cornish T et al. Grading of Well-differentiated Pancreatic Neuroendocrine Tumors Is Improved by the Inclusion of Both Ki-67 Proliferative Index and Mitotic Rate. Am J Surg Path 2013; 37 (11): 1671–7.
3. Remes SM, Tuominen VJ, Helin H et al. Grading of Neuroendocrine Tumors With Ki-67 Requires High-quality Assessment Practices. Am J Surg Path 2012; 36 (9): 1359–63.
4. Basturk O, Tang L, Hruban RH et al. Poorly Differentiated Neuroendocrine Carcinomas of the Pancreas. A Clinicopathologic Analysis of 44 Cases. Am J Surg Pathol 2014; 38: 437–47.
5. Travis WD, Brambilla E, Müller-Hermelink HK, Harris CC. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. World Health Organization Classification of Tumours. Vol 10. IARC Press: Lyon, France, 2004.
6. Travis WD. Advances in neuroendocrine lung tumors. Review. Ann Oncol 2010; 21 (Suppl. 7): vii 65–vii 71.
7. Travis WD. Update on small cell carcinoma and its differentiation from squamous cell carcinoma and other non-small cell carcinomas. Modern Pathology 2012; 25: S18–S30.
8. Gustafsson BI, Kidd M, Chan A et al. Bronchopulmonary neuroendocrine tumors. Cancer 2008; 113 (1): 5–21.
9. Rekhtman N. Neuroendocrine Tumors of the Lung: An Update. Archives of Pathology & Laboratory Medicine 2010; 134 (11): 1628–38.
10. Moran CA, Suster S, Coppola D et al. Neuroendocrine carcinomas of the lung: a critical analysis. Anatomic Path 2009; 131: 206–21.
11. Aslan DL, Gulbahce HE, Pambuccian SE et al. Ki-67 immunoreactivity in the differential diagnosis of pulmonary neuroendocrine neoplasms in specimens with extensive crush artifact. Am J Clin Pathol 2005; 123 (6): 874–8.
12. Skov BG, Holm B, Erreboe A et al. ERCC1 and Ki67 in small cell lung carcinoma and other neuroendocrine tumors of the lung: distribution and impact on survival. J Thorac Oncol 2010; 5 (4): 453–9.
13. Klimstra D, Modlin I, Coppola D et al. The Pathologic Classification of Neuroendocrine Tumors A Review of Nomenclature, Grading, and Staging Systems. Pancreas 2010; 39: 707–12.
14. Walts AE, Ines D, Marchevsky AM. Limited role of Ki-67 proliferative index in predicting overall short-term survival in patients with typical and atypical pulmonary carcinoid tumors. Mod Pathol 2012; 25 (9): 1258–64.
15. Rindi G et al. Grading the neuroendocrine tumors of the lung: an evidence-based proposal. Endocrine-Related Cancer 2014; 21: 1–16
16. Brambilla E, Lantuejoul S. Thoracic neuroendocrine tumors. Histopathology and tumor biology. Ann Pathol 2005; 25 (6): 529–44.
Авторы
Л.Е.Гуревич1, В.В.Делекторская2
1 ГБУЗ МО МОНИКИ им. М.Ф.Владимирского;
2 ФГБУ Российский онкологический научный центр им. Н.Н.Блохина РАМН, Москва