Grade 3 Pancreatic Neuroendocrine Tumors on MDCT: Establishing a Diagnostic Model and Comparing Survival Against Pancreatic Ductal Adenocarcinoma

Chen, Haiyan; Zhang, Xueyan; Deng, Xue-Ying; Ge, Yinglin; Tang, Yu; Cui, Heng; Yang, Bo; Pan, Yao; Shi, Dan; Yu, Ri‐Sheng

doi:10.2214/ajr.19.21921

Cited by 10 publications

(5 citation statements)

References 24 publications

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“…Unlike NEN in the gastrointestinal tract and pancreas that have their own staging system, GB‐NEN are routinely staged using the same system as gallbladder adenocarcinomas. However, the clinical course and patient prognosis of NEN usually differ from those of the adenocarcinomas at the same site 51,52 . A multivariate survival analysis in our study failed to show that advanced tumor was an independent risk factor for GB‐NEC, which was in consistent with a previous study 1 .…”

Section: Discussionsupporting

confidence: 89%

“…However, the clinical course and patient prognosis of NEN usually differ from those of the adenocarcinomas at the same site. 51,52 A multivariate survival analysis in our study failed to show that advanced tumor was an independent risk factor for GB-NEC, which was in consistent with a previous study. 1 In addition, we found that lymph node metastasis and lymphadenectomy had no effect on the median OS of the patients.…”

Section: Factors Associated With Patient Survivalsupporting

confidence: 92%

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Clinicopathological characteristics and prognostic factors of patients with primary gallbladder neuroendocrine carcinomas

Wang

Yang

et al. 2022

J of Digest Diseases

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Objectives Primary gallbladder neuroendocrine carcinomas (GB‐NEC) are malignant neoplasms that remained to be studied. In this study we aimed to summarize their clinicopathological characteristics, effective treatment and prognostic factors for patients with GB‐NEC. Methods Patients with GB‐NEC admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital and Renji Hospital, School of Medicine, Shanghai Jiao Tong University from October 2012 to August 2020 were enrolled. Clinicopathological characteristics of our patients and those reported in previous studies were recorded. The Kaplan‐Meier method and univariate and multivariate Cox regression analyses were used for survival analysis. Results Altogether 15 patients from our hospitals and 47 patients from previous studies were included. A total of 55 patients who underwent surgical resection, including R0 and non‐R0 resection, had significantly longer overall survival compared with the other seven patients. A univariate analysis indicated that patients aged 60 years or older, with jaundice, carcinoid syndrome, non‐R0 resection, and advanced stage were associated with worse survival. A multivariate analysis showed that patients aged 60 years or older, carcinoid syndrome and non‐R0 resection, but not lymphadenectomy and adjuvant chemotherapy, were independently related to reduced survival. Conclusions R0 resection should be the first‐line treatment for GB‐NEC. Older age, carcinoid syndrome and non‐R0 resection are independently associated with reduced survival after surgical resection.

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Section: Discussionsupporting

confidence: 89%

Section: Factors Associated With Patient Survivalsupporting

confidence: 92%

Clinicopathological characteristics and prognostic factors of patients with primary gallbladder neuroendocrine carcinomas

Wang

Yang

et al. 2022

J of Digest Diseases

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“…In this study, furthermore, we devised a nomogram model incorporating clinical features, including jaundice, age, and tumor size, which exhibited good performance in predicting PNENs with a ki67 index > 55%. The performance of our model was comparable to that of imaging-based models [ 3 , 6 ]. However, our study was a single center study with limited sample size.…”

Section: Discussionmentioning

confidence: 62%

The association between jaundice and poorly differentiated pancreatic neuroendocrine neoplasms (Ki67 index > 55.0%)

Liu,

Wang,

Zhou

et al. 2023

BMC Gastroenterol

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Background Jaundice occurs in some pancreatic disease. However, its occurrences and role in pancreatic neuroendocrine neoplasms (PNENs) has not been well studied. In this study we showed the association between jaundice and the risk of high grade and poorly differentiated PNENs. Methods Ninety-three patients with head-neck PNENs were included. Poorly differentiated pancreatic neuroendocrine neoplasms were defined by a ki67 index > 55.0%. Logistic regression was used to show the association between demographic information, clinical signs and symptoms and the risk of poorly differentiated tumors. A nomogram model was developed to predict poorly differentiated tumor. Results Eight of 93 PNEN patients (8.6%) had jaundice. The age and ki67 index in patients with jaundice were significantly higher than those patients without jaundice. All jaundice occurred in patients with grade 3 PNENs. Mutivariable regression analysis showed that age (odds ratio(OR) = 1.10, 95% confidence interval (CI):1.02–1.19), tumor size (OR = 1.42, 95%CI:1.01-2.00) and jaundice (OR = 14.98, 95%CI: 1.22-184.09) were associated with the risk of poorly differentiated PNENs. The age and size combination showed a good performance in predicting poorly differentiated PNENs (area under the curve (AUC) = 0.81, 95% CI: 0.71–0.90). The addition of jaundice further improved the age- and size-based model (AUC = 0.86, 95% CI: 0.78–0.91). A nomogram was developed based on age, tumor size and jaundice. Conclusion Our data showed that jaundice was associated with the risk of high grade PNENs and poorly differentiated PNENs.

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“…Recently, another study found that blood concentration of FAS ligand (FASLG) was lower in 42 PanNEN G-3 compared to controls, and that positive FASLG immunoreactivity in tumor cells correlated with well-differentiated morphology (14/42 evaluable samples) [ 34 ]; suggesting that FASLG could be a future candidate biomarker. Finally, PanNET G-3 rarely show high levels of carbohydrate antigen (CA) 19–9 compared with pancreatic adenocarcinoma [ 35 ]. These preliminary results on biomarker assessments in NET G-3 need confirmation by future studies.…”

Section: Epidemiological Features and Tumor Presentationmentioning

confidence: 99%

“…Regarding PanNEN, one study showed that OS for both NET G-2 and NET G-3 patients was similar (67.8 and 54.1 months, respectively; p = 0.02) and significantly higher than for NEC patients (11 months) [ 7 ]. Patients with PanNET G-3 also show better OS than those with ductal pancreatic adenocarcinoma [ 35 ]. These results indicate that NET G-3′s prognosis falls in between that of NET G-2 and NEC, and more data are needed for non-pancreatic lesions.…”

Section: Epidemiological Features and Tumor Presentationmentioning

confidence: 99%

Digestive Well-Differentiated Grade 3 Neuroendocrine Tumors: Current Management and Future Directions

Pellat

Palmieri

Soyer

et al. 2021

Cancers

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Digestive well-differentiated grade 3 neuroendocrine tumors (NET G-3) have been clearly defined since the 2017 World Health Organization classification. They are still a rare category lacking specific data and standardized management. Their distinction from other types of neuroendocrine neoplasms (NEN) not only lies in morphology but also in genotype, aggressiveness, functional imaging uptake, and treatment response. Most of the available data comes from pancreatic series, which is the most frequent tumor site for this entity. In the non-metastatic setting, surgical resection is recommended, irrespective of grade and tumor site. For metastatic NET G-3, chemotherapy is the main first-line treatment with temozolomide-based regimen showing more efficacy than platinum-based regimen, especially when Ki-67 index <55%. Targeted therapies, such as sunitinib and everolimus, have also shown some positive therapeutic efficacy in small samples of patients. Functional imaging plays a key role for detection but also treatment selection. In the second or further-line setting, peptide receptor radionuclide therapy has shown promising response rates in high-grade NEN. Finally, immunotherapy is currently investigated as a new therapeutic approach with trials still ongoing. More data will come with future work now focusing on this specific subgroup. The aim of this review is to summarize the current data on digestive NET G-3 and explore future directions for their management.

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Grade 3 Pancreatic Neuroendocrine Tumors on MDCT: Establishing a Diagnostic Model and Comparing Survival Against Pancreatic Ductal Adenocarcinoma

Cited by 10 publications

References 24 publications

Clinicopathological characteristics and prognostic factors of patients with primary gallbladder neuroendocrine carcinomas

Clinicopathological characteristics and prognostic factors of patients with primary gallbladder neuroendocrine carcinomas

The association between jaundice and poorly differentiated pancreatic neuroendocrine neoplasms (Ki67 index > 55.0%)

Digestive Well-Differentiated Grade 3 Neuroendocrine Tumors: Current Management and Future Directions

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