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Well-differentiated or poorly-differentiated neuroendocrine tumor with Ki67 >20% (WHO 201...

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IDRF-NET-HIGH-GRADE-G3
TipoSinal de alerta
Estadoreviewed 2026-05-03 | pending_clinical_signoff
DoençasDIS-GI-NET DIS-PNET
FontesSRC-CLARINET-CAPLIN-2014 SRC-NCCN-NET-2025

Origem da bandeira vermelha

DefiniçãoWell-differentiated or poorly-differentiated neuroendocrine tumor with Ki67 >20% (WHO 2019 G3). High-grade disease is clinically and therapeutically distinct from G1/G2: well-differentiated G3 pNET may still respond to everolimus/sunitinib/SSA but outcomes are inferior; poorly differentiated neuroendocrine carcinoma (NEC, Ki67 typically >55%) requires platinum- etoposide chemotherapy (CAPEOX/EP/IP). Engine flag routes to MDT review.
Direcção clínicaintensificar
Categoriahigh-risk-biology
Algoritmo de deslocamentosALGO-PNET-METASTATIC-1L, ALGO-GI-NET-ADVANCED-1L

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": ">",
      "finding": "ki67_percent",
      "threshold": 20
    },
    {
      "comparator": ">",
      "finding": "ki67_proliferation_index",
      "threshold": 20
    },
    {
      "comparator": ">",
      "finding": "mitotic_rate_per_10hpf",
      "threshold": 20
    }
  ],
  "type": "biomarker"
}

Notas

Reverted to draft: true pending second source (SRC-ESMO-NET-2024 or similar) per §6.1 two-reviewer quality gate. Currently only cites SRC-NCCN-NET-2025. WHO 2019 split G3 NETs into two categories: (1) Well-differentiated G3 NET: Ki67 20–100% but preserved architecture (trabecular/glandular); often arise from G2 or de novo in pNET. mTOR/TKI/SSA may still apply; CAPTEM shown active in pNET G3. (2) Poorly differentiated NEC (small cell / large cell): Ki67 typically >55–70%; platinum-etoposide (EP) backbone; not eligible for SSA antiproliferative therapy. NCCN: treat like SCLC/LCNEC. This RF fires at Ki67 >20% to route both to MDT review. The treating team distinguishes G3 well-differentiated vs NEC via morphology + Ki67 level + CDX2/synaptophysin/chromogranin staining pattern.

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