Small Neuroendocrine Tumors of the Whole Gastrointestinal Tract Performed Endoscopic or Surgical Resections Also Show Positive for Lymphovascular Invasion

Digestion ◽  
2021 ◽  
pp. 1-8
Author(s):  
Haruna Miyashita ◽  
Takuji Yamasaki ◽  
Yoshihiro Akita ◽  
Yoshitaka Ando ◽  
Yuki Maruyama ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Tumor Size ◽  
Lymphovascular Invasion ◽  
Distant Metastases ◽  
High Rate ◽  
Ki 67 ◽  
Primary Endpoints ◽  
Invasion Impact ◽  
Prognostic Stratification

<b><i>Background and Aims:</i></b> In gastrointestinal neuroendocrine tumors (GI-NETs), tumor size and grading based on cellular proliferative ability indicate biological malignancy but not necessarily clinically efficient prognostic stratification. We analyzed tumor size- and grading-based prevalence of lymphovascular invasion in GI-NETs to establish whether these are true biological malignancy indicators. <b><i>Methods:</i></b> We included 155 cases (165 lesions), diagnosed histologically with GI-NETs, that had undergone endoscopic or surgical resection. Patient age, sex, method of treatment, tumor size, invasion depth, lymphovascular invasion positivity according to Ki-67 index-based neuroendocrine tumor grading, distant metastases, and outcome were evaluated. The primary endpoints were the prevalence of lymphovascular invasion according to tumor size and grading. <b><i>Results:</i></b> Overall, 24.8% were positive for lymphovascular invasion. There was a high rate of lymphovascular invasion positivity even among grade 1 cases (22.8%). The rate of lymphovascular invasion was 3.4% for grade 1 cases &#x3c;5 mm, with a lymphovascular invasion rate of 8.7% for those 5–10 mm. Lymphovascular invasion ≤10% required a tumor size ≤8 mm, and lymphovascular invasion ≤5% required a tumor size ≤6 mm. A cutoff of 6 mm was identified, which yielded a sensitivity of 79% and a specificity of 63%. Even small GI-NETs grade 1 of the whole GI tract also showed positive for lymphovascular invasion. <b><i>Conclusions:</i></b> GI-NETs ≤10 mm had a lymphovascular invasion prevalence exceeding 10%. The lymphovascular invasion impact in GI-NET development is incompletely understood, but careful follow-up, including consideration of additional surgical resection, is crucial in cases with lymphovascular invasion.

scholarly journals Clear Cell Carcinoma of the Endometrium: Evaluation of Prognostic Parameters in 27 Cases

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhiyang Zhang ◽  
Penglian Gao ◽  
Zhengqi Bao ◽  
Linggong Zeng ◽  
Junyi Yao ◽  
...  
Keyword(s):  
Overall Survival ◽  
Distant Metastasis ◽  
Survival Data ◽  
Tumor Size ◽  
Lymphovascular Invasion ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Molecular Characteristics ◽  
Clinicopathologic Features ◽  
Ki 67

ObjectiveClear cell carcinoma (CCC) of the endometrium is an uncommon yet aggressive tumor. Few cohort studies are reporting the overall survival time of CCC patients. This study aimed to retrospectively analyze the clinicopathologic features, molecular characteristics and survival data of 27 endometrial CCC patients to improve the understanding of CCC.MethodsThe clinicopathologic features, molecular characteristics and survival data total of 27 CCC patients admitted to the BBMU affiliated hospital (Anhui, China) between January 2005 and December 2018 were retrospectively analyzed. Kaplan-Meier method was used to analyze the prognosis-related factors.ResultsThe median age of the patients was 60 years (range; 39 to 81 years). The average tumor size was 3.8 cm (range; 0.8 to 13.0cm). Myometrial infiltration greater than 50% was reported in 55.6% of the patients, while the Ki-67 index greater than 50% was reported in 70.4% of the patients. The patients’ FIGO (2009) surgical stages were as follows: 18 I, 3 II, 4 III, and 2 IV. Besides, 7 (25.6%) patients had lymphovascular invasion, 3 (11.1%) patients with distant metastasis, including 1 patient with bone metastasis, and 2 with liver metastasis. Adjuvant treatment included 7 with chemotherapy alone, 9 with radiotherapy alone, and 9 with both radiotherapy and chemotherapy. The median overall survival time from the time of CCC diagnosis was 56 months. ER and PR showed negative expression and P16 showed patchy immunostaining. 18 (63%) cases showed Napsin A positive expression. Loss of MSH2, MSH6 and PTEN were seen in 5, 4 and 7 cases respectively. All cases showed HER-2/nue negative expression.ConclusionCCC is a rare and invasive tumor. Age of diagnosis, FIGO stage, tumor size, myometrial infiltration, lymphovascular invasion, distant metastasis, Ki-67 index and P53 expression are important indicators to evaluate patient’s prognosis (P = 0.048, P &lt; 0.001, P = 0.016, P = 0.043, P = 0.001, P &lt; 0.001, P = 0.026, and P = 0.007, respectively). CCC has a worse prognosis than endometrioid carcinoma (P = 0.002), and there is no significant difference when compared with uterine papillary serous carcinoma (P = 0.155).

STAT3 inhibition for gastroenteropancreatic neuroendocrine tumors: Potential for a new therapeutic target?

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 340-340
Author(s):  
Alexandra G Lopez-Aguiar ◽  
Lauren McLendon Postlewait ◽  
Mohammad Zaidi ◽  
Kristen Zhelnin ◽  
Alyssa Krasinskas ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Lymphovascular Invasion ◽  
Therapeutic Option ◽  
Microvascular Density ◽  
Vascular Tumors ◽  
Vegf Expression ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Ki 67 ◽  
Low Expression ◽  
Stat3 Inhibition

340 Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are highly vascular tumors with similar treatments applied to all sites. The expression of pro-angiogenic factors (STAT3, VEGF, and HIF-1α) and their association with known adverse pathologic factors and disease recurrence after resection is not known. Methods: All pts with non-metastatic primary GEP-NETs who underwent curative-intent resection at a single institution from 2000-2013 were included. Immunohistochemistry was performed for STAT3, VEGF, HIF-1α, Ki-67 index, and CD31 using tissue microarrays made in triplicate by a pathologist blinded to other clinicopathologic variables. STAT3, VEGF, and HIF-1α were categorized into high vs low expression; CD31 was dichotomized at the median value. Primary outcome was 3-yr recurrence-free survival (3-yr RFS); secondary outcomes were correlation of STAT3, VEGF, and HIF-1α expression with Ki-67 index, adverse pathologic factors, and CD31 expression, a marker of microvascular density. Results: Of 265 GEP-NETs resected, 144 had tissue for analysis. STAT3 expression was high in 12 (8%) and low in 132 (92%). VEGF expression was high in 19 (13%) and low in 125 (87%), and HIF-1α was high in 1 (1%) and low in 143 (99%). High STAT3 expression was associated with worse 3-yr RFS compared to low expression (55% vs 84%; p = 0.003). High VEGF expression had a 3-yr RFS of 76% compared to 82% for low expression (p = 0.098); HIF-1α expression was not associated with RFS. Ki-67 ≥3% was associated with worse 3-yr RFS (≥3%: 51% vs < 3%: 84%; p < 0.001), as was the presence of lymphovascular invasion (LVI: 72% vs 95%; p = 0.001) and increased microvascular density per µm2 (CD31 > median: 75% vs CD31 < median: 86%; p = 0.043). High STAT3 expressing tumors were more likely to have a Ki-67≥3% (42% vs 7%; p < 0.001). LVI was present in 82% of high STAT3 tumors compared to only 50% with low STAT3 (p = 0.058). CD31 overexpression was similar between groups (58% vs 49%; p = 0.5). Conclusions: In resected GEP-NETs, high STAT3 expression is associated with an increased Ki-67 index, presence of lymphovascular invasion, and worse 3-yr RFS. STAT3 inhibition may be a novel therapeutic option for patients undergoing resection of high-risk tumors.

Is there an Optimal Surgical Approach to Neuroendocrine Tumors of the Ampulla? A Single Institution Experience over 15 Years

2016 ◽  
Vol 82 (7) ◽  
pp. 637-643 ◽  
Author(s):  
Gillian G. Baptiste ◽  
Lauren M. Postlewait ◽  
Cecilia G. Ethun ◽  
Nina Le ◽  
Maria C. Russell ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neuroendocrine Tumors ◽  
Surgical Approach ◽  
Tumor Size ◽  
Regional Lymph Node ◽  
Ki 67 ◽  
Advanced Tumor ◽  
Tumor Node Metastasis Stage ◽  
The Mean ◽  
Aggressive Tumors

Neuroendocrine tumors (NETs) of the ampulla of Vater are rare neoplasms accounting for a small fraction of gastroenteropancreatic NETs. The optimal surgical approach remains controversial. This study aimed to define the optimal approach in patients with ampullary NETs. Patients who underwent resection of ampullary NETs from 2000 to 2014 were analyzed. Fourteen patients with well-differentiated, nonfunctional NETs were identified. The mean age was 60 ± 15 years, and nine (64%) were male. The mean tumor size was 1.6 ± 0.9 cm and the majority (61%) had an advanced tumor-node-metastasis stage. Eight (57%) patients underwent pancreaticoduodenectomy (PD) and six (43%) underwent transduodenal ampullectomy (TA). Although the mean tumor size was similar (1.7 vs 1.5 cm), the majority (75 vs 20%) of PD patients demonstrated a trend toward more aggressive tumors, characterized by advance T stage in 25 vs 0 per cent, lymph node positivity in 88 vs 17 per cent, and elevated proliferative index (Ki-67) in 25 vs 0 per cent. Complete resection (R0) was achieved in all PD patients versus 75 per cent in TA patients. There was no difference in major complication rate (50 vs 33%). In the TA group, one (17%) patient recurred and two (33%) patients died, whereas only one (13%) patient died in the PD group and no patients recurred. In conclusion, ampullary tumors can be aggressive tumors characterized by high regional lymph node involvement. A transduodenal approach may provide an inadequate oncological resection and thus has the potential to understage ampullary NETs. In the era of increasing therapeutic options for gastroenteropancreatic NETs, accurate staging is crucial and appropriate oncologic resection via PD for ampullary NETs should be considered.

Loco-regional outcomes of a population-based cohort of rectal neuroendocrine tumors.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 668-668
Author(s):  
Erica S Tsang ◽  
Yarrow Jean McConnell ◽  
David F. Schaeffer ◽  
Caroline Speers ◽  
Hagen F. Kennecke
Keyword(s):  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Local Excision ◽  
Univariate Analysis ◽  
Local Relapse ◽  
Population Based ◽  
Mitotic Count ◽  
Margin Status ◽  
Ki 67 ◽  
Pelvic Radiation

668 Background: Optimal management of rectal neuroendocrine tumors (NETs) is not well defined. We characterized the clinicopathologic features, loco-regional, and systemic management of a population-based cohort of rectal NETs. Methods: Patients diagnosed with rectal NETs from 1999-2011 were identified from British Columbia provincial databases. NETs were classified as G1 and G2 tumors with a Ki-67 ≤ 20% and/or mitotic count ≤ 20 per high power field. Results: Of 91 rectal NETs, median age was 58 (IQR 48-65) years and 35 (38%) were male. Median tumor size was 6 (IQR 4-8) mm. Median overall survival was 164.7 months, with 3 patients presenting with stage IV disease. Treatment included local excision (n = 79), surgical resection (n = 6), and pelvic radiation (n = 1; T3N1 tumor). Final margin status was positive in 17 (20%) cases. Local relapse occurred in 8 (9%) cases, and one relapse to bone 13 months after T3N1 tumor resection. Univariate analysis demonstrated an association between local relapse and T classification, Ki-67, mitotic count, grade, and perineural invasion (p< 0.01), but not N or M classification, or lymphovascular invasion. Local relapse was not associated with surgical management or margin status. Of 3 patients with metastatic disease, two received systemic management, with capecitabine and temozolomide. Conclusions: Rectal NETs generally presented with small, early tumors and were treated with local excision or surgical resection without pelvic radiation. [Table: see text]

Defining the role of lymphadenectomy for pancreatic neuroendocrine tumors: An eight institution study of 695 patients from the U.S. Neuroendocrine Tumor Study Group.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 212-212
Author(s):  
Alexandra G Lopez-Aguiar ◽  
Mohammad Zaidi ◽  
Mary Dillhoff ◽  
Eliza W Beal ◽  
George A. Poultsides ◽  
...  
Keyword(s):  
Risk Factors ◽  
Distal Pancreatectomy ◽  
Neuroendocrine Tumors ◽  
Tumor Size ◽  
Pancreatic Neuroendocrine Tumors ◽  
Ki 67 ◽  
Curative Intent ◽  
Factors Associated ◽  
Regional Lymphadenectomy ◽  
Preoperative Factors

212 Background: Preoperative factors that reliably predict lymph node (LN) metastases in pancreatic neuroendocrine tumors (PanNETs) are unclear. The number of LNs needed to accurately stage PanNETs has not been defined. Methods: Patients who underwent curative-intent resection of primary non-functional PanNETs at 8 institutions from 2000-2016 were analyzed. Tumors with poor differentiation and Ki-67 > 20% were excluded. Preoperative factors associated with LN metastases were identified. A procedure specific target for LN retrieval to accurately stage patients was determined. Results: Of 2182 pts with GI NETs, 695 underwent resection of PanNETs. 33% of tumors were proximal (head/uncinate), and 67% were distal (neck/body/tail). 26% of pts (n = 158) had LN+ disease, which was associated with worse 5-yr recurrence-free survival (RFS) (60% vs 86%; p < 0.001). Increasing number of +LNs was not associated with worse RFS. Preoperative factors associated with +LNs included tumor size ≥2 cm (OR 6.6; p < 0.001), proximal location (OR 2.5; p < 0.001), moderate vs well differentiation (OR 2.1; p = 0.006), and Ki-67≥3% (OR 3.1; p < 0.001). LN metastases were also present in tumors without these risk factors: < 2cm (9%), distal location (19%), well differentiated (23%), and Ki-67 < 3% (16%). Median LN retrieval was 13 for pancreatoduodenectomy (PD), but only 9 for distal pancreatectomy (DP). Given that PD routinely includes a complete regional lymphadenectomy, a minimum number of LNs to accurately stage pts was not identified. For DP, however, removal of < 7 LNs failed to discriminate 5-yr RFS between LN (+) and (-) pts ( < 7 LNs: 72% vs 83%, p = 0.198; ≥7 LNs: 67% vs 86%, p = 0.002). Conclusions: Tumor size ≥2 cm, proximal location, moderate differentiation, and Ki-67≥3% are preoperative factors that predict LN positivity in resected non-functional PanNETs. Given the 9-23% incidence of LN metastases in patients without such risk factors, routine regional lymphadenectomy should be considered. Pancreatoduodenectomy inherently includes sufficient LN retrieval, while distal pancreatectomy should aim to remove ≥7 LNs for accurate staging.

Should all pancreatic neuroendocrine tumors (PNET) over 1 cm be resected?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4108-4108
Author(s):  
Diana Hsu ◽  
Sidney Le ◽  
Alex Chang ◽  
Austin Spitzer ◽  
George Kazantsev ◽  
...  
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Metastatic Disease ◽  
Tumor Size ◽  
Cox Regression ◽  
Metastatic Spread ◽  
Rank Test ◽  
Pancreatic Neuroendocrine Tumors ◽  
Localized Disease

4108 Background: Pancreatic neuroendocrine tumors (PNET) are a heterogeneous group of tumors that represent 1-2% of all pancreatic neoplasms. Their biologic behaviors are unpredictable with high grade, nodal metastasis, or liver metastasis lending an unfavorable prognosis. Current guidelines recommend resection for functioning tumors and those 2 cm or larger but are less straightforward regarding tumors < 2 cm in size. Previous data show that observation for nonfunctioning tumors < 2 cm can be safe and feasible; however, a significant portion of these patients may have nodal involvement or metastatic disease. Methods: A retrospective review was undertaken to identify patients with pancreatic neuroendocrine tumors treated at Northern California Kaiser Permanente (KP-NCAL) between February 2010 and December 2018. Univariate and multivariate analyses were performed with the log-rank test and Cox regression. Chi-squared test of relevant clinicopathologic factors determined which factors were predictive for overall survival (OS). Results: Mean age was 61 years in our cohort of 354 patients, with 29% over the age of 70. Mean tumor size was 3.43 cm; 32% of tumors were 2 cm or smaller. 51% of the patients had localized disease; 32% of the patients presented with metastatic disease. The pancreatic tail was the most common tumor location (38%), followed by the head of the pancreas (24%). On multivariate survival analysis, stage, location of the tumor, and surgical resection were statistically significant in terms of overall survival ( p<.001). Mean OS for patients with localized and metastatic disease was 93 months versus 37 months ( p<.001). Surgery was utilized in 8.9% of patients with metastatic disease ( p<.001). All patients with PNET smaller than 1 cm in our study group had localized disease only. However, in patients with tumor size between 1 and 2 cm, 11% had nodal or metastatic spread. Conclusions: PNETs are indolent but have malignant potential at any size. In our retrospective study, all of the patients with tumor size < 1 cm had localized disease. For those with PNETs 1-2 cm in size, 11% had nodal or metastatic spread. Based on our findings, we suggest a more aggressive surgical resection size criteria of 1 cm.[Table: see text]

Predicting Aggressive Behavior in Nonfunctional Pancreatic Neuroendocrine Tumors With Emphasis on Tumor Size Significance and Survival Trends: A Population-Based Analysis of 1787 Patients

2020 ◽  
Vol 86 (5) ◽  
pp. 458-466
Author(s):  
Amir H. Fathi ◽  
Jonathan Romanyshyn ◽  
Mehdi Barati ◽  
Uzair Choudhury ◽  
Allen Chen ◽  
...  
Keyword(s):  
Aggressive Behavior ◽  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Tumor Size ◽  
Cox Proportional Hazards ◽  
Pancreatic Neuroendocrine Tumors ◽  
Clinicopathologic Characteristics ◽  
Patient Age ◽  
Patient Âgé ◽  
The Impact

Background Nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors with continued controversies in management. This study aims to identify demographic and clinicopathologic characteristics associated with aggressive behavior and survival. Methods The Surveillance, Epidemiology, and End Results database was used to identify patients with NF-PNETs from 1988 to 2012. Multivariate regression analysis and Cox proportional hazards modeling were used to assess the impact of patient, tumor, and treatment characteristics on tumor behavior and overall survival. Results In 1787 patients identified, size was a major determinant of aggressive behavior. The probability of aggressiveness increased 100% for tumor size ≥2 cm. For tumors ≥2 cm, every 1-cm increase in size was associated with an increase in probability of aggressive behavior by 11.3%. Patient age, tumor grade, and surgical resection were independent predictors of survival. Surgical resection was associated with improved survival but not grade I or II tumors with size <2 cm. Discussion Patient age, tumor size, and grade should be in the decision-making process around the surgical management of NF-PNETs. For tumors ≤2 cm with histologic grades of I or II, the probability of aggressive behavior is low, and surgical resection does not appear to afford survival benefit. Therefore, close observation could be justified.

scholarly journals Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 771
Author(s):  
Francesco Maione ◽  
Alessia Chini ◽  
Marco Milone ◽  
Nicola Gennarelli ◽  
Michele Manigrasso ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Lymphovascular Invasion ◽  
Muscularis Propria ◽  
Biological Behavior ◽  
Detection Rates ◽  
The Past ◽  
Intermediate Size ◽  
Well Differentiated ◽  
Metastatic Risk

Rectal neuroendocrine tumors (NETs) are rare, with an incidence of 0.17%, but they represent 12% to 27% of all NETs and 20% of gastrointestinal NETs. Although rectal NETs are uncommon tumors, their incidence has increased over the past few years, and this is probably due to the improvement in detection rates made by advanced endoscopic procedures. The biological behavior of rectal NETs may be different: factors predicting the risk of metastases have been identified, such as size and grade of differentiation. The tendency for metastatic diffusion generally depends on the tumor size, muscular and lymphovascular infiltration, and histopathological differentiation. According to the current European Neuroendocrine Tumor Society (ENETS) guidelines, tumors that are smaller than 10 mm and well differentiated are thought to have a low risk of lymphovascular invasion, and they should be completely removed endoscopically. Rectal NETs larger than 20 mm have a higher risk of involvement of muscularis propria and high metastatic risk and are candidates for surgical resection. There is controversy over rectal NETs of intermediate size, 10–19 mm, where the metastatic risk is considered to be 10–15%: assessment of tumors endoscopically and by endoanal ultrasound should guide treatment in these cases towards endoscopic, transanal, or surgical resection.

Pancreatic neuroendocrine tumors: Twenty years’ experience of 100 patients at a single center.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 179-179
Author(s):  
Satoshi Shiba ◽  
Chigusa Morizane ◽  
Shunsuke Kondo ◽  
Hideki Ueno ◽  
Masafumi Ikeda ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Survival Rates ◽  
Case Series ◽  
Distant Metastases ◽  
World Health ◽  
Endocrine Tumors ◽  
Pancreatic Neuroendocrine Tumors ◽  
Primary Tumors ◽  
Pancreatic Endocrine Tumors

179 Background: Pancreatic neuroendocrine tumors (NETs) are rare neoplasms that exhibit a variety of diverse morphological, functional and behavioral characteristics. However, only a few reports have evaluated large case series of pancreatic endocrine tumors. Methods: We conducted a retrospective review of 100 consecutive patients with pancreatic NETs diagnosed pathologically and treated at the National Cancer Center Hospital between 1991 and 2010. Results: The characteristics of the 100 patients were as follows: male, 49; female, 51; median age, 55 years. Fourteen patients gave a history of endocrine symptoms at the time of diagnosis. The primary tumors arose in the head, body and tail of the pancreas in 54, 25 and 21 patients, respectively. According to the 2010 grading classification of the World Health Organization, 11 patients were classified as having NET G1, 44 as having NET G2 and 29 as having NEC. The five-year survival rates of the patients with NET G1, NET G2 and NEC were 91%, 78% and 12%, respectively. The five-year survival rates of the patients with stage I, II and III, and IV disease classified according to the American Joint Committee on Cancer (AJCC) were 100%, 68% and 9%, respectively. Distant metastases occurred in 18% percent of the NET G1 patients, 39% of the NET G2 patients and 83% of the NEC patients. Treatment was undertaken by surgical resection in 82%, 59% and 24% of patients with NET G1, NET G2 and NEC, respectively. The five-year survival rates of the patients with NET G1, NET G2 and NEC after radical surgery were 100%, 91% and 36%, respectively. Among the 33 patients treated by systemic chemotherapy, the median survival period was 22.9 months in the patients with NET G1/G2 and 6.6 months in those with NEC. A multivariate analysis identified lower age, good performance status (PS) and lower histopathologic grade as independent favorable prognostic factors. Conclusions: Patients with NET G1, G2 treated by surgical resection had a good prognosis. Most patients with NEC exhibited distant metastases and had a poor prognosis. Histopathologic grade is an important factor for selecting the appropriate treatment strategy and predicting the prognosis in patients with pancreatic NETs.

Indications for Surgical Resection in Low-Grade Pancreatic Neuroendocrine Tumors

2016 ◽  
Vol 82 (8) ◽  
pp. 737-742 ◽  
Author(s):  
Timothy L. Fitzgerald ◽  
Catalina Mosquera ◽  
Haily S. Vora ◽  
Nasreen A. Vohra ◽  
Emmanuel E. Zervos
Keyword(s):  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Tumor Size ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Low Grade ◽  
Pancreatic Neuroendocrine Tumors ◽  
Free Survival ◽  
Increased Risk ◽  
Disease Free

The role of surgical resection in low-grade pancreatic neuroendocrine tumors (P-NET) is unclear. The patients diagnosed with low-grade P-NET from 1988 to 2012 were identified in SEER. Five hundred and sixty-one patients met the inclusion criteria. A majority were white (82.9%), and node negative (69.9%). Univariate analysis revealed that tumor size (<2 cm 8.3%, 2–4 cm 38.5%, and >4 cm 40.3%; P < 0.0001) and surgery (30.9% vs 25.3%; P = 0.0014) were associated with the risk of lymph node metastases (LNM). In contrast, age ( P = 0.8360), gender ( P = 0.4903), and race ( P = 0.4235) were not. Five-year disease-free survival was associated with size (<2 cm 89.4%, 2–4 cm 80.0%, and >4 cm 74.5%; P = 0.0089), LNM (72.4% vs 82.9%; P = 0.0025), and surgery (84.3% vs 47.5%; P < 0.0001). Cox regression model showed that the association with LNM ( P = 0.0025) and surgery ( P < 0.0001) was significant. Surgery was associated with an improved disease-free survival for tumors >2 cm (2–4 cm, 84.4% vs 26.0% at five years; P = 0.0003, and >4 cm, 80.5% vs 49.5% at five years; P < 0.0001) but not for those with tumor size <2 cm ( P = 0.4525). In conclusions, low-grade P-NETs in patients with tumor size >2 cm showed an increased risk of LNM and improved survival with resection.

Sign in / Sign up

Export Citation Format

Share Document