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

• Published in: British journal of cancer 2014-10, Vol.111 (9), p.1703-1709
• Main Authors: Dobson, R, Burgess, M I, Valle, J W, Pritchard, D M, Vora, J, Wong, C, Chadwick, C, Keevi, B, Adaway, J, Hofmann, U, Poston, G J, Cuthbertson, D J
• Format: Article
• Language: English
• Subjects: 692/699/67/1459/1963; 692/699/67/322; 692/699/75; 692/700/1421/1860/1445; Aged; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cancer; Cancer Research; Carcinoid Heart Disease - diagnosis; Carcinoid Heart Disease - etiology; Carcinoid Heart Disease - mortality; Cardiovascular disease; Clinical Study; Disease Progression; Drug Resistance; Echocardiography; Epidemiology; Female; Follow-Up Studies; Heart; Hospitals; Humans; Liver Neoplasms - complications; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Male; Medical prognosis; Medical sciences; Metastasis; Molecular Medicine; Mortality; Neoplasm Grading; Neuroendocrine tumors; Neuroendocrine Tumors - complications; Neuroendocrine Tumors - mortality; Neuroendocrine Tumors - pathology; Oncology; Patients; Prognosis; Prospective Studies; Serotonin; Surveillance; Survival Rate; Tumors
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2014.468

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.