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)

<b><i>Objectives:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.

**研究目的**：目前针对已接受切除手术的胃肠胰神经内分泌肿瘤（gastroenteropancreatic neuroendocrine tumours, NETs）的最优随访方案，学界尚未达成统一共识。本研究拟通过开展实践调查，明确医疗从业者的随访诊疗模式，并梳理存在实践差异的领域，为后续开展定量研究指明方向。**研究方法**：本研究由肿瘤内科医师与研究方法学家组成的指导委员会牵头开发网络调查问卷，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诊疗医护人员进行调研。问卷共包含37个问题，用于收集医护人员对诊疗指南的依从情况、风险因素对随访方案的影响，以及随访检查的频率与检查方式选择等相关信息。**研究结果**：本次调研共回收有效问卷163份，其中澳大利亚59份、新西兰25份、加拿大46份、美国33份；受访者专科构成包括50%的肿瘤内科医师、23%的外科医师、13%的核医学医师，以及15%的其他专科医护人员。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）发布的胃肠胰神经内分泌肿瘤诊疗指南，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；但仅分别有15%、27%、10%的受访者认为上述指南"极具临床实用性"。63%的受访者称其所在医疗机构未采用相关指南。临床中最常用的随访检查为CT扫描（66%）与嗜铬粒蛋白A（chromogranin A）检测（86%）。美国受访者更倾向于对患者实施5年以上的长期随访，而澳大利亚受访者则更多采用功能成像检查，较少使用横断面成像。当引入不良预后因素时，受访者会建议增加随访频次与检查项目。**研究结论**：这项大规模国际调研凸显了当前胃肠胰神经内分泌肿瘤随访实践存在显著差异，而现有指南并未对此进行充分规范。未来需开展更多定量研究，以基于肿瘤复发模式制定循证且适配性更强的随访指南。