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Teresa Ramone Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Cristina Romei Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Raffaele Ciampi Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Roberta Casalini Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Angelo Valetto Department of Laboratory Medicine, Section of Cytogenetics, University Hospital of Pisa, Pisa, Italy

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Veronica Bertini Department of Laboratory Medicine, Section of Cytogenetics, University Hospital of Pisa, Pisa, Italy

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Francesco Raimondi Laboratorio di Biologia Bio@SNS, Scuola Normale Superiore, Pisa, Italy

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Anthony Onoja Laboratorio di Biologia Bio@SNS, Scuola Normale Superiore, Pisa, Italy

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Alessandro Prete Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Antonio Matrone Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Carla Gambale Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Paolo Piaggi Department of Information Engineering, University of Pisa, Pisa, Italy

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Liborio Torregrossa Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Pathology, University Hospital of Pisa, Pisa, Italy

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Clara Ugolini Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Pathology, University Hospital of Pisa, Pisa, Italy

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Rossella Elisei Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Somatic copy number alterations (SCNA) involving either a whole chromosome or just one of the arms, or even smaller parts, have been described in about 88% of human tumors. This study investigated the SCNA profile in 40 well-characterized sporadic medullary thyroid carcinomas by comparative genomic hybridization array. We found that 26/40 (65%) cases had at least one SCNA. The prevalence of SCNA, and in particular of chromosome 3 and 10, was significantly higher in cases with a RET somatic mutation. Similarly, SCNA of chromosomes 3, 9, 10 and 16 were more frequent in cases with a worse outcome and an advanced disease. By the pathway enrichment analysis, we found a mutually exclusive distribution of biological pathways in metastatic, biochemically persistent and cured patients. In particular, we found gain of regions involved in the intracellular signaling and loss of regions involved in DNA repair and TP53 pathways in the group of metastatic patients. Gain of regions involved in the cell cycle and senescence were observed in patients with biochemical disease. Finally, gain of regions associated with the immune system and loss of regions involved in the apoptosis pathway were observed in cured patients suggesting a role of specific SCNA and corresponding altered pathways in the outcome of sporadic MTC.

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Sara Pusceddu Department of Medical Oncology ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

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Francesco Barretta Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy

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Annalisa Trama Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Evaluative Epidemiology Unit, ENETS Center of Excellence, Milan, Italy

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Laura Botta Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Evaluative Epidemiology Unit, ENETS Center of Excellence, Milan, Italy

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Massimo Milione Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, ENETS Center of Excellence, Milan, Italy

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Roberto Buzzoni Department of Medical Oncology ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

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Filippo De Braud Department of Medical Oncology ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
University of Milan, Milan, Italy

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Vincenzo Mazzaferro University of Milan, Milan, Italy
Liver Surgery, Transplantation and Gastroenterology, University of Milan and Istituto Nazionale Tumori Fondazione IRCCS, ENETS Center of Excellence, Milano, Milan, Italy

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Ugo Pastorino Department of Thoracic Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, ENETS Center of Excellence, Milan, Italy

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Ettore Seregni Department of Nuclear Medicine ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Milan, Italy

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Luigi Mariani Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy

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Gemma Gatta Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Evaluative Epidemiology Unit, ENETS Center of Excellence, Milan, Italy

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Maria Di Bartolomeo Department of Medical Oncology ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

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Daniela Femia Department of Medical Oncology ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

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Natalie Prinzi Department of Medical Oncology ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

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Jorgelina Coppa Liver Surgery, Transplantation and Gastroenterology, University of Milan and Istituto Nazionale Tumori Fondazione IRCCS, ENETS Center of Excellence, Milano, Milan, Italy

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Francesco Panzuto Department of Medical Gastroenterology, Azienda Ospedaliera Sant’Andrea, Roma ENETS Center of Excellence, Rome, Italy

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Lorenzo Antonuzzo Department of Medical Oncology, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy

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Emilio Bajetta Department of Medical Oncology, Policlinico di Monza, Monza, Italy

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Maria Pia Brizzi Department of Medical Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy

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Davide Campana Department of Medical Oncology, Policlinico Sant’Orsola Malpighi, Bologna, Italy

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Laura Catena Department of Medical Oncology, Policlinico di Monza, Monza, Italy

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Harry Comber Ireland National Cancer Registry, Cork, Ireland

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Fiona Dwane Ireland National Cancer Registry, Cork, Ireland

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Nicola Fazio Department of Medical Oncology, IEO – Istituto Europeo di Oncologia, Milano, ENETS Center of Excellence, Milan, Italy

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Antongiulio Faggiano Department of Thyroid and Parathyroid Surgery Unit, Azienda Ospedaliera Universitaria Federico II, ENETS Center of Excellence, Naples, Italy

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Dario Giuffrida Department of Medical Oncology, IOM – Istituto Oncologico del Mediterraneo, Catania, Italy

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Kris Henau Belgian Cancer Registry, Brussels, Belgium

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Toni Ibrahim Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST, IRCCS, Meldola, Italy

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Riccardo Marconcini Department of Medical Oncology, Ospedale Santa Chiara, Pisa, Italy

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Sara Massironi Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy

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Maja Primic Žakelj Institute of Oncology Ljubljana, Epidemiology and Cancer Registry, Ljubljana, Slovenia

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Francesca Spada Department of Medical Oncology, IEO – Istituto Europeo di Oncologia, Milano, ENETS Center of Excellence, Milan, Italy

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Salvatore Tafuto Department of Medical Oncology, Fondazione IRCCS Pascale, ENETS Center of Excellence, Naples, Italy

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Elizabeth Van Eycken Belgian Cancer Registry, Brussels, Belgium

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Jan Maaten Van der Zwan Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

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Tina Žagar Institute of Oncology Ljubljana, Epidemiology and Cancer Registry, Ljubljana, Slovenia

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Luca Giacomelli Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy

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Rosalba Miceli Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy

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NEPscore Working Group
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No validated prognostic tool is available for predicting overall survival (OS) of patients with well-differentiated neuroendocrine tumors (WDNETs). This study, conducted in three independent cohorts of patients from five different European countries, aimed to develop and validate a classification prognostic score for OS in patients with stage IV WDNETs. We retrospectively collected data on 1387 patients: (i) patients treated at the Istituto Nazionale Tumori (Milan, Italy; n = 515); (ii) European cohort of rare NET patients included in the European RARECAREnet database (n = 457); (iii) Italian multicentric cohort of pancreatic NET (pNETs) patients treated at 24 Italian institutions (n = 415). The score was developed using data from patients included in cohort (i) (training set); external validation was performed by applying the score to the data of the two independent cohorts (ii) and (iii) evaluating both calibration and discriminative ability (Harrell C statistic). We used data on age, primary tumor site, metastasis (synchronous vs metachronous), Ki-67, functional status and primary surgery to build the score, which was developed for classifying patients into three groups with differential 10-year OS: (I) favorable risk group: 10-year OS ≥70%; (II) intermediate risk group: 30% ≤ 10-year OS < 70%; (III) poor risk group: 10-year OS <30%. The Harrell C statistic was 0.661 in the training set, and 0.626 and 0.601 in the RARECAREnet and Italian multicentric validation sets, respectively. In conclusion, based on the analysis of three ‘field-practice’ cohorts collected in different settings, we defined and validated a prognostic score to classify patients into three groups with different long-term prognoses.

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