Head and body/tail pancreatic neuroendocrine tumors have different biological characteristics and clinical outcomes

Mei, Wentong; Ding, Yixuan; Wang, Shuo; Jia, Yuchen; Cao, Feng; Li, Fei

doi:10.1007/s00432-020-03303-w

Cited by 16 publications

(21 citation statements)

References 30 publications

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“…Similar to our finding, Mei et al. found that tumors located in the pancreatic head were more likely to have LNM compared with those in the body/tail (42.8% vs. 30.9%, p < 0.001) and were associated with poor survival ( 25 ). The different embryological origins of the head and body/tail of the pancreas may partly contribute to these differences.…”

Section: Discussionsupporting

confidence: 91%

Prognostic Factors of Small Non-Functional Pancreatic Neuroendocrine Tumors and the Risk of Lymph Node Metastasis: A Population-Level Study

Tan

Wang

et al. 2022

Front. Endocrinol.

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BackgroundSmall non-functional neuroendocrine tumors (NF-PNETs) are a heterogeneous subset of tumors with controversy regarding their optimal management. We aimed to analyze the prognostic factors of patients with small NF-PNETs and create a risk score for lymph node metastasis (LNM).MethodsData of 751 patients with NF-PNETs ≤ 2 cm were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate survival analysis was performed to analyze the prognostic factors. Logistic regression was used to identify risk factors for LNM.ResultsOf the 751 patients, 99 (13.2%) were confirmed to have LNM. In multivariate survival analysis, LNM (hazard ratio [HR], 2.12; 95% CI, 1.04–4.32, p = 0.040) was independently associated with disease-specific survival. Logistic regression identified that tumor location in the head of the pancreas (odds ratio [OR], 4.33; 95% CI, 2.75–6.81; p < 0.001), size ≥ 1.5–2 cm (OR, 1.84; 95% CI, 1.17–2.87; p = 0.009), and grade III–IV (OR, 7.90; 95% CI, 1.79–34.90; p = 0.006) were independent risk factors of LNM. According to the OR value, the risk of LNM was scored as follows: a score of 1 for tumors located in the body/tail of the pancreas and 4 for those located in the head; a score of 1 for tumors <1 cm and 2 for those ≥1.5–2 cm; and a score of 1 for tumors with grade I–II and 8 for those with grade III–IV. Finally, the median score for this cohort was 4, with an interquartile range of 3–6. Therefore, patients were classified as three groups based on the risk score system: a total score of 1–3 for low risk, 4–6 for intermediate risk (OR, 2.98; 95% CI, 1.59–5.60; p = 0.001), and 7–14 for high risk (OR, 8.94; 95% CI, 4.50–17.7; p < 0.001), with an incidence of LNM 5.0%, 13.5%, and 31.8%, respectively (p < 0.001).ConclusionSurgical resection with regional lymphadenectomy is recommended for small NF-PNETs with malignant potential of LNM. A risk score for LNM based on tumor grade, location, and size may preoperatively predict LNM of small NF-PNETs and guide clinical practice.

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Section: Discussionsupporting

confidence: 91%

Prognostic Factors of Small Non-Functional Pancreatic Neuroendocrine Tumors and the Risk of Lymph Node Metastasis: A Population-Level Study

Tan

Wang

et al. 2022

Front. Endocrinol.

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“… 3 , 4 They are 4 times more frequent in tumors ≥2 cm in size. 3 , 5 , 34 Our study confirmed this data in univariate analysis, as distant metastases were found in 22 (19.3%) patients, in 9.5% of tumors <2 cm, and in 25.0% of tumors ≥2 cm. Twenty (91.0%) cases involved liver, and 2 (9.0%) both liver and bones.…”

Section: Discussionsupporting

confidence: 85%

“…Many studies have reported that poor histologic differentiation correlates with a higher incidence of lymph node metastases. 5 , 30 , 36 In our study, lymph node metastasis occurred in 33.9%, 46.0%, and 62.5% of G1, G2, and G3 tumors, respectively, with no statistically significant difference. This may be due to the different sizes of study groups in other publications.…”

Section: Discussionmentioning

confidence: 43%

“… 2 They are slow-growing tumors with a poor prognosis, worse in the presence of distant metastases 3 , 4 and in tumor size >2 cm. 5 , 6 Also, nodal metastasis, poorly differentiated cells, and vascular invasion worsen the prognosis. 7 According to the literature, distant metastases are found at the time of tumor diagnosis in 20–50% of cases depending on the degree of tumor differentiation.…”

Section: Introductionmentioning

confidence: 99%

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

Molasy¹,

Zemła²,

Mrowiec³

et al. 2022

TCRM

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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.

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“…Tumor location is another associated factor for LNM, with an OR of 4.33. Similar to our finding, Mei et al found that tumors located in the pancreatic head were more likely to have LNM compared with those in the body/tail (42.8% vs. 30.9%, p < 0.001) and were associated with poor survival (25). The different embryological origins of the head and body/tail of the pancreas may partly contribute to these differences.…”

Section: Discussionsupporting

confidence: 89%

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Head and body/tail pancreatic neuroendocrine tumors have different biological characteristics and clinical outcomes

Cited by 16 publications

References 30 publications

Prognostic Factors of Small Non-Functional Pancreatic Neuroendocrine Tumors and the Risk of Lymph Node Metastasis: A Population-Level Study

Prognostic Factors of Small Non-Functional Pancreatic Neuroendocrine Tumors and the Risk of Lymph Node Metastasis: A Population-Level Study

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

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