Analysis of lymph node metastasis in pancreatic neuroendocrine tumors (PNETs) based on the tumor size and hormonal production

Tsutsumi, Kosuke; Ohtsuka, Takao; Mori, Yasuhisa; Fujino, Minoru; Yasui, Takahiro; Aishima, Shinichi; Takahata, Shunichi; Nakamura, Masafumi; Ito, Tetsuhide; Tanaka, Masao

doi:10.1007/s00535-012-0540-0

Cited by 79 publications

(46 citation statements)

References 30 publications

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“…28 In the study by Tsutumi et al, the two patients with node-positive PNET of \10 mm were both gastrinomas. 7 Second, lymph node sampling was not performed in all of the patients. Parekh et al 27 examined the lymph node status of 149 patients who underwent surgical resection and showed that no lymph nodes were identified in the resected surgical specimens in 43 % of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies advocate surgical resection for PNETs of any size because even small tumors can be malignant or metastasize to lymph nodes. [2][3][4][5][6][7][8][9]27 Previous studies showing the incidence of lymph node metastases and/or prognosis according to tumor size were summarized in Table 3. Lymph node metastases were recognized even with PNETs of \10 mm.…”

Section: Discussionmentioning

confidence: 99%

“…2 Provided the tumor is considered resectable, the current consensus on optimal treatment for PNETs at any stage is surgical resection, because lymph node metastases can occur even in patients with PNETs of \10-20 mm. [2][3][4][5][6][7][8][9] Several studies have validated aggressive resection of advanced disease with portal vein tumor thrombosis or hepatic metastases. [10][11][12][13] For non-functional PNETs, irrespective of tumor size, the National Comprehensive Cancer Network guidelines recommend surgical resection, including regional lymph nodes.…”

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confidence: 99%

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Basing Treatment Strategy for Non-functional Pancreatic Neuroendocrine Tumors on Tumor Size

Kishi¹,

Shimada²,

Nara³

et al. 2014

Ann Surg Oncol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Basing Treatment Strategy for Non-functional Pancreatic Neuroendocrine Tumors on Tumor Size

Kishi¹,

Shimada²,

Nara³

et al. 2014

Ann Surg Oncol

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“…These drugs have become reimbursable as antitumor drugs for treating advanced GI-NETs in Japan. Regarding NET, functionality, invasion depth, and the presence or absence of metastases must be correctly evaluated and treatment administered on the basis of the degrees of differentiation and malignancy of the tumor [4,[34][35][36]. Although surgical total excision is the standard treatment [37], some studies report that when radical treatment is difficult, debulking surgery of primary lesions and liver metastatic lesions effectively alleviate symptoms and improve prognosis [4,34,37].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis

et al. 2014

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Background Although neuroendocrine tumors (NETs) are rare, the number of patients with NET is increasing. However, in Japan, there have been no epidemiological studies on NET since 2005; thus, the prevalence of NET remains unknown. Methods We reported the epidemiology of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) [pancreatic neuroendocrine tumors (PNETs) and gastrointestinal neuroendocrine tumors (GI-NETs)] in Japan in 2005. Here, we conducted the second nationwide survey on patients with GEP-NETs who received treatment in 2010. Results A total of 3,379 patients received treatment for PNETs in 2010, representing a 1.2-fold increase in the number of patients from 2005 to 2010. The prevalence was estimated to be 2.69/100,000, with an annual onset incidence of 1.27/100,000 in 2010. Non-functioning tumor (NF)-PNETs comprised 65.5 % of cases followed by insulinoma (20.9 %) and gastrinoma (8.2 %). Interestingly, the number of patients with NF-PNETs increased *1.8 fold since 2005. A total of 19.9 % of patients exhibited distant metastasis at initial diagnosis; 4.3 % had complications with multiple endocrine neoplasia type 1 (MEN-1), and only 4.0 % had NF-PNETs associated with MEN-1. Meanwhile, an estimated 8,088 patients received treatment for GI-NETs, representing a *1.8-fold increase since 2005. The prevalence was estimated to be 6.42/100,000, with an annual onset incidence of 3.51/100,000. The locations of GI-NETs varied: foregut, 26.1 %; midgut, 3.6 %; and hindgut, 70.3 %. Distant metastasis and complications with MEN-1 were observed in 6.0 and 0.42 % at initial diagnosis, respectively. The frequency of carcinoid syndrome in patients with GI-NETs was 3.2 %. Conclusion We clarified the epidemiological changes in GEP-NETs from 2005 to 2010 in Japan.

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“…We elected to jointly analyze these because they are reliably available to a surgeon pre-operatively. Tsutsumi, K., et al, reported increase prevalence of lymph node metastasis in gastrinoma patients and non gastrinoma patients with tumor size ≥ 1.5 cm [26]. They also found that 2 (8%) patients with gastrinoma out of 26 patients with tumor < 1.5 cm had nodal metastasis [26].…”

Section: Discussionmentioning

confidence: 99%

Regional Lymphadenectomy Is Indicated in the Surgical Treatment of Pancreatic Neuroendocrine Tumors (PNETs)

et al. 2014

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Objective To explore the prognostic importance and preoperative predictors of lymph node metastasis in an effort to guide surgical decision making in patients with pancreatic neuroendocrine tumors (PNETs). Background PNETs are uncommon, and the natural history of the disease is not well described. As a result, there remains controversy regarding the optimal management of regional lymph nodes during resection of the primary tumor. Methods A retrospective review of a prospectively maintained database of patients who underwent surgery for locoregional PNET between 1994 and 2012 was performed. Logistic regression was used to identify predictors of nodal metastasis. Overall survival (OS) and disease-free survival (DFS) were calculated using Kaplan Meier method. Results were expressed as p- values and odds ratio estimates with 95% confidence intervals. Results One-hundred thirty six patients were identified, of whom 50 (38%) patients had nodal metastasis. The frequency of lymph node metastasis was higher for: larger tumors (> 1.5 cm (OR= 4.7), tumors of the head as compared to body-tail of the pancreas (OR= 2.8), tumors with Ki-67 > 20% (OR= 6.7), and tumors with lymph vascular invasion (OR= 3.6), (p value <0.05). Median DFS was lower for patients with nodal metastases (4.5 v 14.6 years, p < 0.0001). Conclusions Lymph node metastasis is predictive of poor outcomes in patients with PNETs. Preoperative variables are not able to reliably predict patients where the probability of lymph node involvement was less than 12%. These data support inclusion of regional lymphadenectmy in patients undergoing pancreatic resections for PNET.

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Analysis of lymph node metastasis in pancreatic neuroendocrine tumors (PNETs) based on the tumor size and hormonal production

Abstract: Non-gastrinomas with a tumor size of ≥15 mm and all gastrinomas would be an indication for pancreatectomy with lymph node dissection.

Cited by 79 publications

References 30 publications

Basing Treatment Strategy for Non-functional Pancreatic Neuroendocrine Tumors on Tumor Size

Basing Treatment Strategy for Non-functional Pancreatic Neuroendocrine Tumors on Tumor Size

Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis

Regional Lymphadenectomy Is Indicated in the Surgical Treatment of Pancreatic Neuroendocrine Tumors (PNETs)

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