Evaluation of Risk Factors for Distant and Lymph Node Metastasis of Pancreatic Neuroendocrine Tumors

Abstract

Purpose Metastases of pancreatic neuroendocrine tumors (pNETs) can be found at the time of diagnosis in 20–50% of cases. Small asymptomatic tumors may be left for observation; however, they can metastasize. The aim of the study was to evaluate risk factors for distant and lymph node metastases of pNETs. Patients and methods One hundred and fourteen patients with postoperatively confirmed pNET were analyzed retrospectively in a single ENETS Center of Excellence. The relationship between location, size, differentiation of the tumor, and occurrence of lymph node and distant metastases was analyzed. Results pNETs’ location was pancreatic head – 38 (33.3%), body or tail – 68 (59.7%), and 8 (7.0%) involved the entire organ. Fifty-six (49.1%) tumors were graded G1, 50 (43.9%) G2, and 8 (7.0%) G3. Seventy-two (63.2%) tumors were ≥2 cm in diameter, and 42 (36.8%) <2 cm. Twenty-two (19.3%) patients had distant metastases and 47 (41.2%) had lymph node metastases. In ≥2 cm tumors distant and lymph node metastases were more frequent (p < 0.05). Distant metastases incidence was significantly higher in distally located tumors (p = 0.01) and in G2 and G3 tumors (p < 0.01). In 9.5% of <2cm tumors, distant metastases were present at diagnosis. Conclusion Distant metastases are more often found in larger, distally located pNETs grade G2 and G3, while a higher occurrence of lymph node metastases seems to be associated only with larger tumor size. A considerable number of tumors <2 cm in size have distant metastases already at the diagnosis, which might indicate the need for careful qualification of smaller lesions for observation.

Contemporary Approaches to the Surgical Management of Pancreatic Neuroendocrine Tumors

“…NF-PNETs larger than 2 cm often present in a delayed fashion with mass-like compressive symptoms leading to abdominal pain, nausea, vomiting, or jaundice or in the form of metastatic disease [5,27,28]. Larger tumor size and higher grade are associated with higher metastatic occurrences, with the more common site of metastases being the liver [29,30]. Other sites of metastases include the lymph nodes, peritoneum, and bones, among others [30].…”