scholarly journals Role of Removed Lymph Nodes on the Prognosis of M0 Small-Bowel Neuroendocrine Tumors: a Propensity Score Matching Analysis from SEER Database

2021 ◽  
Author(s):  
Jie-bin Xie ◽  
Yue-shan Pang ◽  
Xun Li ◽  
Xiao-ting Wu
Keyword(s):  
Small Bowel ◽  
Propensity Score ◽  
Lymph Nodes ◽  
Propensity Score Matching ◽  
Neuroendocrine Tumors ◽  
Prognostic Value ◽  
Radical Resection ◽  
Clinicopathological Characteristics ◽  
Seer Database ◽  
Resection Group

Abstract Background Current studies on the number of removed lymph nodes (LNs) and their prognostic value in small-bowel neuroendocrine tumors (SBNETs) are limited. This study aimed to clarify the prognostic value of removed LNs for SBNETs. Methods SBNET patients without distant metastasis from 2004 to 2017 in the SEER database were included. The optimal cutoff values of examined LNs (ELNs) and negative LNs (NLNs) were calculated by the X-tile software. Propensity score matching (PSM) was done to match patients 1:1 on clinicopathological characteristics between the two groups. The Kaplan-Meier method with log-rank test and multivariable Cox proportional-hazards regression model were used to evaluate the prognostic effect of removed LNs. Results The cutoff values of 14 for ELNs and 9 for NLNs could well distinguish patients with different prognoses. After 1:1 PSM, the differences in clinicopathological characteristics between the two groups were significantly reduced (all P > 0.05). Removal of more than one LN significantly improved the prognosis of the patients (P < 0.001). The number of lymphatic metastasis in the sufficiently radical resection group (SRR, 3.74 ± 3.278, ELN > 14 and NLN > 9) was significantly more than that in the insufficiently radical resection group (ISRR, 2.72 ± 3.19, ELN < 14 or NLN < 9). The 10-year overall survival (OS) of the SRR was significantly better than that of the ISRR (HR = 1.65, P = 0.001, 95% CI: 1.24–2.19). Conclusion Both ELNs and NLNs can well predict the OS of patients. Systematic removal of more than 14 LNs and more than 9 NLNs can increase the OS of SBNET patients.

scholarly journals How to Choose the Best Procedure Type for Duodenal Neuroendocrine Tumors With a Maximum Diameter of 1 to 2 Cm a Propensity Score Matching Analysis Based on the SEER Database

2020 ◽  
Author(s):  
Huanyu Tang ◽  
jiebin xie ◽  
Yueshan Pang ◽  
Xia Hua ◽  
xun Li
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Neuroendocrine Tumors ◽  
Treatment Plan ◽  
Clinicopathological Characteristics ◽  
Maximum Diameter ◽  
Seer Database ◽  
Cancer Specific Survival ◽  
Significant Difference ◽  
Duodenal Neuroendocrine Tumors

Abstract Background: The treatment plan for duodenal neuroendocrine tumors (d-NETs) with a diameter between 1 and 2 cm is still controversy. Aim: To compare the effects of local endoscopic resection and radical resection on the prognosis of d-NETs with a maximum diameter of 1-2 cm. Methods: 286 eligible patients were identified from the SEER database. Propensity score matching (PSM) was done to match patients 1:1 on clinicopathological characteristics. Kaplan-Meier analysis was used to analyze the factors affecting the prognosis.Results: Before PSM, there was no significant difference in the cancer-specific survival (CSS) between the two groups (P = 0.595), but the tumor size, T stage, N stage, and M stage were significantly different between the two groups (all P < 0.05). After 1:1 PSM, the differences in clinicopathological characteristics between the two groups were significantly reduced (all P > 0.05). Survival analysis showed that only the tumor grade was correlated with the prognosis (P = 0); surgical method and other clinicopathological characteristics were not correlated with the prognosis (all P > 0.05). Conclusion: The surgical approach had no significant effect on the prognosis of d-NET patients with a maximum diameter of 1-2 cm and without lymph node metastasis.

Comparison of clinical outcomes between enucleation and regular pancreatectomy in patients with non-functional pancreatic neuroendocrine tumors: a retrospective multicenter and propensity score-matched study

2021 ◽  
Author(s):  
Zhen Yang ◽  
Hengjun Gao ◽  
Jun Lu ◽  
Zheyu Niu ◽  
Huaqiang Zhu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Neuroendocrine Tumors ◽  
Disease Free Survival ◽  
Pancreatic Neuroendocrine Tumors ◽  
Free Survival ◽  
Estimated Blood Loss ◽  
Disease Free

Abstract Objective There are limited data from retrospective studies on whether therapeutic outcomes after regular pancreatectomy are superior to those after enucleation in patients with small, peripheral and well-differentiated non-functional pancreatic neuroendocrine tumors. This study aimed to compare the short- and long-term outcomes of regular pancreatectomy and enucleation in patients with non-functional pancreatic neuroendocrine tumors. Methods Between January 2007 and July 2020, 227 patients with non-functional pancreatic neuroendocrine tumors who underwent either enucleation (n = 89) or regular pancreatectomy (n = 138) were included. Perioperative complications, disease-free survival, and overall survival probabilities were compared. Propensity score matching was performed to balance the baseline differences between the two groups. Results The median follow-up period was 60.76 months in the enucleation group and 43.29 months in the regular pancreatectomy group. In total, 34 paired patients were identified after propensity score matching. The average operative duration in the enucleation group was significantly shorter than that in the regular pancreatectomy group (147.94 ± 42.39 min versus 217.94 ± 74.60 min, P &lt; 0.001), and the estimated blood loss was also significantly lesser (P &lt; 0.001). The matched patients who underwent enucleation displayed a similar overall incidence of postoperative complications (P = 0.765), and a comparable length of hospital stay (11.12 ± 3.90 days versus 9.94 ± 2.62 days, P = 0.084) compared with those who underwent regular pancreatectomy. There were no statistically significant differences between the two groups in disease-free survival and overall survival after propensity score matching. Conclusion Enucleation in patients with non-functional pancreatic neuroendocrine tumors was associated with shorter operative time, lesser intraoperative bleeding, similar overall morbidity of postoperative complications, and comparable 5-year disease-free survival and overall survival when compared with regular pancreatectomy.

scholarly journals Prognostic value of Onodera’s nutritional index for intermediate- and high-risk gastrointestinal stromal tumors treated with or without tyrosine kinase inhibitors

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Feng Wang ◽  
Tingting Tao ◽  
Heng Yu ◽  
Yingying Xu ◽  
Zhi Yang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Prognostic Marker ◽  
Gastrointestinal Stromal Tumors ◽  
Prognostic Value ◽  
Kinase Inhibitors ◽  
Rank Test ◽  
Stromal Tumors ◽  
Lymphocyte Ratio ◽  
Nutritional Index

Abstract Background Immunoinflammatory and nutritional markers, such as the peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and Onodera’s prognostic nutritional index (OPNI), have gained considerable attention and have been preliminarily revealed as prognostic markers of gastrointestinal stromal tumors (GISTs). Methods In this study, we first investigated the prognostic value of OPNI in GISTs treated with or without TKIs based on the propensity score matching (PSM) method. All of the patients had received surgical resection for primary GIST, and data from 2010 to 2018 were initially and retrospectively identified from our gastrointestinal center. Recurrence-free survival (RFS) was calculated by the Kaplan–Meier method and compared by the log-rank test. Results The patients were divided into groups treated and not treated with TKIs, and we used the propensity score matching method to homogenize their baseline data. Multivariate Cox proportional hazard regression models were applied to identify associations with outcome variables. A total of 563 GISTs were initially chosen, and 280 of them were included for analysis under the inclusion criteria. After PSM, there were 200 patients included. Multivariate analyses identified OPNI as an independent prognostic marker that was associated with primary site, tumor size, mitotic index, tumor rupture, necrosis, and modified NIH risk classification. Low OPNI (< 42.6; HR 0.409; P < 0.001) was associated with worse RFS. Conclusions Preoperative OPNI is a novel and useful prognostic marker for GISTs both treated and not treated with TKIs. Higher NLR and PLR have negative effects on RFS.

Defining the number of lymph nodes needed to accurately stage small bowel neuroendocrine tumors: An 8-institution study from the US neuroendocrine tumor study group.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 265-265
Author(s):  
Mohammad Zaidi ◽  
Alexandra G Lopez-Aguiar ◽  
Mary Dillhoff ◽  
Eliza W Beal ◽  
George A. Poultsides ◽  
...  
Keyword(s):  
Small Bowel ◽  
Lymph Nodes ◽  
Neuroendocrine Tumor ◽  
Neuroendocrine Tumors ◽  
Lymph Node Staging ◽  
Study Group ◽  
Curative Intent ◽  
Tumor Study ◽  
The Us ◽  
Tumor Study Group

265 Background: Small bowel neuroendocrine tumors (SB-NETs) frequently involve regional lymph nodes (LNs). The prognostic value of LN positivity on recurrence of disease is not well defined. The number of LNs needed to accurately stage patients is unknown. Methods: All patients with primary SB-NETs who underwent curative-intent resection at 8 institutions in the US Neuroendocrine Tumor Study Group between 2000 and 2016 were identified. Patients with distant metastatic disease were excluded. The association of LN positivity with recurrence of disease and the extent of lymphadenectomy required were analyzed. Results: Of 2182 patients with resected NETs, 203 had SB-NETs. Median age was 60 yrs, 56% were male, and median follow-up was 39 months. 83.5% of patients (n = 157) had LN positive disease. There was no difference in 3-year recurrence free survival (3-yr RFS) among patients with 1 or 2 positive LNs compared to patients with negative LNs (p = 0.63). Patients who had 3 or more positive LNs had a worse 3-yr RFS compared to those with 0, 1, or 2 positive LNs (n = 92 vs n = 73; 3-yr RFS 82% vs 92%; p < 0.001). Retrieval of 8 or more LNs was associated with a higher positive LN count compared to less than 8 LNs (4.6 vs. 1.6; p = 0.002). However, an increasing LN ratio was not associated with 3-yr RFS. When examining patients who had less than 8 lymph nodes retrieved, there was no difference in 3-yr RFS in those patients with 3 or more positive LNs compared to those with 0, 1, or 2 positive LNs (3-yr RFS: 100% vs 91%; p = 0.37). Retrieval of more than 8 lymph nodes, however, accurately discriminated patients with 3 or more positive LNs compared to those with 0, 1, or 2 positive LNs (3-yr RFS: 79.7% vs 93.5%; p = 0.005). Conclusions: For patients undergoing curative-intent resection of small bowel NETs, accurate lymph node staging requires a minimum of 8 lymph nodes for examination. 3 or more positive LNs is associated with decreased 3-yr RFS compared to 0, 1, or 2 positive lymph nodes. A thorough regional lymphadenectomy is critical for accurate staging and management of patients with small bowel neuroendocrine tumors.

scholarly journals Survival of patients with appendiceal neuroendocrine tumors: whether they benefit from right hemicolectomy?

2020 ◽  
Author(s):  
Haiping Lin ◽  
Liyuan Wang ◽  
Yang Bai ◽  
Chenyang Ge ◽  
Hongjuan Zheng ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Neuroendocrine Tumors ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Right Hemicolectomy ◽  
Prognostic Impact ◽  
Subdistribution Hazard ◽  
Survival Difference

Abstract Background: Current guidelines recommend right hemicolectomy for appendiceal neuroendocrine tumors (A-NETs) patients with lymph node (LN) metastasis. However, prognosis of these patients is favorable, and the prognostic impact of metastatic LN is controversial.Objective: The study aims to evaluate the prognostic factors of A-NETs, and explore whether right hemicolectomy/ more extended procedure (RHCM) improves prognosis compared to less extended than right hemicolectomy (LRHC).Methods: Patients with A-NETs were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The Fine-Gray proportional hazards model was established to calculate subdistribution hazard ratios of prognostic factors. A propensity score matching was performed to balance intergroup differences between the LRHC and RHCM groups, and survival difference between the after-matched groups was tested using the Gray test. Subgroup analyses were also conducted.Results: In the multivariate analysis, histological type and distant metastatic status were associated with prognosis, while tumor size and nodal status were not. After propensity score matching, the patients’ characteristics were well balanced. RHCM did not confer survival benefits in the whole after-matched patients or any subgroup.Conclusions: Metastatic LN does not significantly impact prognosis, and RHCM fails to improve prognosis compared to LRHC. Therefore, the current “LN-decided” surgical procedure may not be suitable for patients with A-NETs.

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