Serial surveillance of carcinoid heart disease: factors associated with echocardiographic progression and mortality.

Abstract

BACKGROUND:

Carcinoid heart disease is a complication of metastatic neuroendocrine tumours (NETs). We sought to identify factors associated with echocardiographic progression of carcinoid heart disease and death in patients with metastatic NETs.

METHODS:

Patients with advanced non-pancreatic NETs and documented liver metastases and/or carcinoid syndrome underwent prospective serial clinical, biochemical, echocardiographic and radiological assessment. Patients were categorised as carcinoid heart disease progressors, non-progressors or deceased. Multinomial regression was used to assess the univariate association between variables and carcinoid heart disease progression.

RESULTS:

One hundred and thirty-seven patients were included. Thirteen patients (9%) were progressors, 95 (69%) non-progressors and 29 (21%) patients deceased. Baseline median levels of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and plasma 5-hydroxyindoleacetic acid (5-HIAA) were significantly higher in the progressors. Every 100 nmol l(-1) increase in 5-HIAA yielded a 5% greater odds of disease progression (OR 1.05, 95% CI: 1.01, 1.09; P=0.012) and a 7% greater odds of death (OR 1.07, 95% CI: 1.03, 1.10; P=0.001). A 100 ng l(-1) increase in NT-proBNP did not increase the risk of progression, but did increase the risk of death by 11%.

CONCLUSIONS:

The biochemical burden of disease, in particular baseline plasma 5-HIAA concentration, is independently associated with carcinoid heart disease progression and death. Clinical and radiological factors are less useful prognostic indicators of carcinoid heart disease progression and/or death.

• Authors: R Dobson, M I Burgess, J W Valle, D M Pritchard, J Vora, C Wong, C Chadwick, B Keevi, J Adaway, U Hofmann, G J Poston, D J Cuthbertson
• Journal: British journal of cancer (Br J Cancer) Vol. 111 Issue 9 Pg. 1703-9 (Oct 28 2014) ISSN: 1532-1827 [Electronic] England
• PMID: 25211656 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Carcinoid Heart Disease (diagnosis, etiology, mortality)
• Disease Progression
• Echocardiography
• Female
• Follow-Up Studies
• Humans
• Liver Neoplasms (complications, mortality, secondary)
• Male
• Neoplasm Grading
• Neuroendocrine Tumors (complications, mortality, pathology)
• Prognosis
• Prospective Studies
• Survival Rate