Supplementary Material for: Follow-Up for Resected Gastroenteropancreatic Neuroendocrine Tumours: A Practice Survey of the Commonwealth Neuroendocrine Tumour Collaboration (CommNETS) and the North American Neuroendocrine Tumor Society (NANETS)

Objectives: There is no consensus regarding optimal follow-up in resected gastroenteropancreatic neuroendocrine tumours (NETs). We aimed to perform a practice survey to ascertain follow-up patterns by health care practitioners and highlight areas of variation that may benefit from further quantitative research. Methods: A Web-based survey targeted at NET health care providers in Australia, New Zealand, Canada, and the USA was developed by a steering committee of medical oncologists and a research methodologist. Thirty-seven questions elicited information regarding adherence to guidelines, the influence of risk factors on follow-up, and the frequency and choice of modality in follow-up. Results: There were 163 respondents: 59 from Australia, 25 from New Zealand, 46 from Canada, and 33 from the USA (50% medical oncology, 23% surgery, 13% nuclear medicine, and 15% other). Thirty-eight percent of the respondents were “very familiar” with the NCCN NET guidelines, 33% with the ENETS guidelines, and 17% with the ESMO guidelines; however, only 15, 27, and 10%, respectively, found them “very useful”; 63% reported not using guidelines at their institution. The commonest investigations used were CT scans (66%) and chromogranin A (86%). The US respondents were more likely to follow patients up past 5 years, and the Australian respondents utilized more functional and less cross-sectional imaging. When poor prognostic factors were introduced, the respondents recommended more visits and tests. Conclusions: This large international survey highlights variation in current follow-up practices not well addressed by the current guidelines. More quantitative research is required to inform the development of evidence-based guidelines tailored to the pattern of recurrence in NETs.

研究目标：针对已切除的胃肠胰神经内分泌肿瘤（gastroenteropancreatic neuroendocrine tumours, NETs）的最佳随访方案，目前尚无统一共识。本研究旨在开展一项实践调查，明确医疗从业者的随访模式，并识别出可通过进一步定量研究优化的实践差异领域。
研究方法：本研究由医学肿瘤学家与研究方法学家组成的指导委员会开发了一项基于网络的调查问卷，针对澳大利亚、新西兰、加拿大及美国的胃肠胰神经内分泌肿瘤医疗服务提供者展开调研。问卷共包含37个问题，用于收集指南依从性、风险因素对随访方案的影响，以及随访检查的频率与方式选择等相关信息。
研究结果：本次调查共回收163份有效问卷：其中澳大利亚59份，新西兰25份，加拿大46份，美国33份；受访者构成包括50%的医学肿瘤学家、23%的外科医师、13%的核医学医师及15%的其他相关从业者。38%的受访者表示“非常熟悉”美国国家综合癌症网络（National Comprehensive Cancer Network, NCCN）神经内分泌肿瘤指南，33%熟悉欧洲神经内分泌肿瘤学会（European Neuroendocrine Tumor Society, ENETS）指南，17%熟悉欧洲肿瘤内科学会（European Society for Medical Oncology, ESMO）指南；但仅有15%、27%及10%的受访者认为上述指南“非常实用”；63%的受访者表示所在机构未采用相关指南。临床中最常用的检查方式为计算机断层扫描（computed tomography, CT，66%）与嗜铬粒蛋白A（chromogranin A，86%）。美国受访者更倾向于对患者进行5年以上的随访，而澳大利亚受访者则更多使用功能成像，较少采用横断面成像。当引入不良预后因素时，受访者建议增加随访次数与检查项目。
研究结论：这项大规模国际调研凸显了当前随访实践存在显著差异，而现有指南并未对此作出充分规范。未来需开展更多定量研究，以制定基于循证医学依据、适配胃肠胰神经内分泌肿瘤复发模式的个性化随访指南。