Pancreatic neuroendocrine tumors: Single institution review over 10 years.

e15183 Background: Pancreatic neuroendocrine tumors(pNET) are rare tumors accounting for less than 5% of pancreatic cancer. They are functionally and biologically heterogeneous and have not been studied in great detail until recently. Methods: We conducted a retrospective review of 79 consecutive patients with pNET diagnosed and treated at Thomas Jefferson University Hospital between the years of 2000 and 2010. Results: Of the 79 patients whose records were reviewed, 32 were male and 47 were female. Median age at diagnosis was 61 years. Two cases were associated with MEN1 syndrome. Primary tumor arose in the head, body and tail of the pancreas in 15, 10 and 26 patients, resp. In 6 patients, the tumor was multifocal. The neuroendocrine tumor was accompanied by pancreatic adenocarcinoma in 1 patient and intraductal papillary mucinous neoplasm in 3. In 10 patients, distant metastasis was detected, involving liver only. Tumor was functional in 9 patients: 5 insulinoma, 2 gastrinoma,1 glucagonoma and 1 VIPoma. As per TNM staging, 28, 22 and 10 patients were Stage I, II and III, and IV at diagnosis. Treatment by surgical resection was undertaken in 54 patients. In 21 patients, the tumor was discovered incidentally; 21 patients presented with abdominal pain. Other symptoms were irregular bowel movements, weight loss and jaundice. 51 of the 79 (64.5%) patients were alive at last follow up. On univariate analysis, median survival for females was 137 months vs 114 months for male. Median survival for patients with functional tumors was similar to those with nonfunctioning tumors (118 and 115 months, resp). Median survival for patients with Stage I, II, and III and Stage IV patients were 234,112 and 40 months resp. Median survival for patients who underwent surgical resection was 130 months vs those who did not (30 months). Conclusions: Majority of pNET were located in the body and tail of pancreas; an area requiring thorough scrutiny with special imaging studies for diagnosis. Only a minority of patients presented with liver metastasis(12%) and a smaller number showed hormonal activity (11%). Prognosis improved markedly in patients who underwent surgical resection. Therefore, whenever appropriate, surgical resection should be the treatment of choice in patients with pNET.

Download Full-text

Stage I nonfunctioning neuroendocrine tumors of the pancreas: Surgery or surveillance?

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.349 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 349-349 ◽

Cited By ~ 2

Author(s):

J. R. Strosberg ◽

A. Cheema ◽

L. K. Kvols

Keyword(s):

Surgical Resection ◽

Neuroendocrine Tumors ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

The Body ◽

Stage I ◽

Pancreatic Neuroendocrine Tumors ◽

Partial Pancreatectomy ◽

Fine Needle ◽

Cystic Tumors

349 Background: An increasing number of nonfunctioning, early-stage pancreatic neuroendocrine tumors are detected incidentally as patients undergo radiographic procedures for unrelated indications. Endoscopic sonography with fine-needle aspiration now enables nonoperative biopsy of tumors smaller than 1 cm in diameter. It is unclear whether the risks of partial pancreatectomy or enucleation exceed the risks of surveillance in patients with these neoplasms. Methods: We performed a database search of patients with pancreatic neuroendocrine tumors treated at the H. Lee Moffitt Cancer Center in order to evaluate outcomes of patients with stage I tumors who did not undergo surgical resection. Results: Four patients were identified who elected to undergo surveillance of their stage I tumors instead of surgical resection. All had been diagnosed via endoscopic ultrasound-guided fine-needle aspiration. The tumor sizes were 7 mm, 12 mm, 13 mm, and 15 mm at initial diagnosis. Three tumors were cystic and one was solid. Three were located in the body of the pancreas and one in the tail. In two patients, the Ki-67 index was measured and was <1%. With a median of follow-up of two years, none of the patients experienced tumor growth. All three patients with cystic tumors experienced shrinkage of their tumors following the diagnostic needle aspiration and did not experience subsequent increase in size (Table). Conclusions: Surveillance may be an appropriate strategy for management of incidentally discovered, stage I pancreatic neuroendocrine tumors. [Table: see text] No significant financial relationships to disclose.

Download Full-text

Prognostic Validity of the American Joint Committee on Cancer Eighth Edition Staging System for Well-Differentiated Pancreatic Neuroendocrine Tumors: A Retrospective Multinational Multicenter Study

10.21203/rs.3.rs-86061/v1 ◽

2020 ◽

Author(s):

Hebin Wang ◽

Ding Ding ◽

Tingting Qin ◽

Jun Liu ◽

Hang Zhang ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Staging System ◽

Tnm Staging ◽

Stage I ◽

Pancreatic Neuroendocrine Tumors ◽

American Joint Committee ◽

Staging Systems ◽

Significant Difference ◽

Well Differentiated ◽

Eighth Edition

Abstract Background:There is no widely-accepted staging system for pancreatic neuroendocrine tumors (pNETs). The aim of this study was to validate the American Joint Committee on Cancer (AJCC) 8th edition staging system for well-differentiated (G1/G2) pNETs.Methods:A multicenter dataset (n=1086) was used to evaluate the application of the AJCC 7th and 8th, the European Neuroendocrine Tumor Society (ENETS), and the modified ENETS (mENETS) staging systems for well-differentiated pNETs.Results:The proportion of patients with stage III tumors was extremely low (1.1%) according to the AJCC 7th staging system. For the ENETS staging system, patients with stage IIIA disease had worse estimated mean survival than patients with stage IIIB disease (78.9 vs. 107.3 months). When comparing with patients in stage I, the AJCC 7th, ENETS, and mENETS staging systems showed good performance in discriminating between stages; however, there was no significant difference in some stages when the reference was defined as the earlier stage. When the reference was defined as stage I or the earlier stage, there was a significant inter-stage difference in the AJCC 8th staging system.Conclusions:The AJCC 8th staging system is more suitable for pNETs than other TNM staging systems and may be adopted in clinical practice.

Download Full-text

Incidental diagnosis of pancreatic neuroendocrine tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.190 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 190-190

Author(s):

A. Cheema ◽

L. K. Kvols ◽

J. R. Strosberg

Keyword(s):

Neuroendocrine Tumors ◽

Early Stage ◽

Hormone Secretion ◽

Survival Rates ◽

Stage Iv ◽

Stage I ◽

Cancer Center ◽

Pancreatic Neuroendocrine Tumors ◽

7Th Edition ◽

Symptomatic Diagnosis

190 Background: Pancreatic neuroendocrine tumors are often discovered incidentally during radiologic or endoscopic examinations. The incidence of incidental detection is unknown. It is also unclear whether patients with incidentally discovered, asymptomatic tumors should be treated similarly to patients who present with tumor-related symptoms. Methods: A database of 425 patients with pancreatic neuroendocrine tumors treated at the H. Lee Moffitt Cancer Center was developed. Patient charts were reviewed to assess whether their diagnosis was incidental or prompted by tumor-related symptoms such as pain, jaundice, or neuroendocrine hormone secretion. The frequency of “incidentalomas” was categorized by TNM stage (AJCC, 7th edition). Overall survival was stratified by “incidental” versus “symptomatic” diagnosis. Results: Among 425 patients with histologically proven pancreatic neuroendocrine tumors, 112 patients (26%) had tumors that were discovered incidentally. The majority of stage I tumors (55%) were incidentally discovered. Among patients with stage IV tumors, 20% were detected incidentally (Table). Median survival of patients with incidentally discovered tumors was 103 months versus 84 months in patients who were symptomatic at diagnosis. Conclusions: A sizeable fraction of patients with pancreatic neuroendocrine tumors are diagnosed incidentally during evaluations for other conditions or unrelated symptoms. The majority of patients with stage I tumors are incidentally diagnosed. The increased incidence of pancreatic neuroendocrine “incidentaloms” may be contributing to improving survival rates in this disease. This study highlights the necessity of developing guidelines for management of patients with incidentally discovered, early-stage tumors. [Table: see text] No significant financial relationships to disclose.

Download Full-text

Association of preoperative monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with overall survival after resection of pancreatic neuroendocrine tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.216 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 216-216

Author(s):

Roheena Z. Panni ◽

Jesse T Davidson ◽

Bradley A. Krasnick ◽

Martha McGilvray ◽

Jorge Zarate Rodriguez ◽

...

Keyword(s):

Overall Survival ◽

Median Survival ◽

Neuroendocrine Tumors ◽

Univariate Analysis ◽

Prognostic Significance ◽

Neutrophil To Lymphocyte Ratio ◽

Pancreatic Neuroendocrine Tumors ◽

Roc Curve Analysis ◽

Lymphocyte Ratio ◽

The Difference

216 Background: Neutrophil, monocyte and lymphocyte counts are important biomarkers of the tumor-induced systemic inflammatory response. A lower monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) is associated with a favorable prognosis for certain tumors. However, this association has not yet been demonstrated in resected pancreatic neuroendocrine tumors (PNETs). The aim of this study was to investigate the prognostic significance of MLR and NLR in patients with resectable PNETs with regards to overall survival (OS). Methods: Eligible patients undergoing surgery for PNETs between 2000 and 2016 were identified using a national multi-center cohort dataset. Their pre-operative neutrophil, monocyte and lymphocyte counts were imported and NLR and MLR were calculated. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut offs for NLR and MLR. Univariate analyses were used to compare patient factors and tumor characteristics in different groups. The difference in OS between high and low groups was explored with the use of Kaplan Meier curves and compared using log-rank tests. Results: A total of 635 patients were analyzed. Univariate analysis revealed that higher lymphocyte, low monocyte and low neutrophil counts were associated with improved OS (P = 0.0002, 0.014 and 0.011 respectively). The mean NLR and MLR level was 4.11 ± 0.219 and 0.4295 ± 0.0196, respectively. Lower NLR ( < 4) and lower MLR ( < 0.25) were significantly associated with improved OS (p < 0.001 & p < 0.0001). Median survival was 141 months in the low NLR group (n = 474) and 119 months in the high NLR group (n = 161). The median survival in the high MLR group (n = 464) was 120 months and has not been reached in the low MLR group (n = 171). On multivariate analysis, low MLR was independent predictor of improved OS when controlling for age, race and comorbidities (p < 0.001). Conclusions: For resectable PNETs, low pre-operative NLR and MLR levels are significantly associated with improved survival. NLRs and MLRs may serve as valuable markers to stratify PNET patients for subsequent therapies and clinical trial enrollment.

Download Full-text

Indications for Surgical Resection in Low-Grade Pancreatic Neuroendocrine Tumors

The American Surgeon ◽

10.1177/000313481608200834 ◽

2016 ◽

Vol 82 (8) ◽

pp. 737-742 ◽

Cited By ~ 4

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.

Download Full-text