Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study

Abstract

Background: Identifying patients at risk for early recurrence (ER) following resection for pancreatic neuroendocrine tumors (pNETs) might help to tailor adjuvant therapies and surveillance intensity in the post-operative setting. Methods: Patients undergoing surgical resection for pNETs between 1998–2018 were identified using a multi-institutional database. Using a minimum p-value approach, optimal cut-off value of recurrence-free survival (RFS) was determined based on the difference in post-recurrence survival (PRS). Risk factors for early recurrence were identified. Results: Among 807 patients who underwent curative-intent resection for pNETs, the optimal length of RFS to define ER was identified at 18 months (lowest p-value of 0.019). Median RFS was 11.0 months (95% 8.5–12.60) among ER patients (n = 49) versus 41.0 months (95% CI: 35.0–45.9) among non-ER patients (n = 77). Median PRS was worse among ER patients compared with non-ER patients (42.6 months vs. 81.5 months, p = 0.04). On multivariable analysis, tumor size (OR: 1.20, 95% CI: 1.05–1.37, p = 0.007) and positive lymph nodes (OR: 4.69, 95% CI: 1.41–15.58, p = 0.01) were independently associated with ER. Conclusion: An evidence-based cut-off value for ER after surgery for pNET was defined at 18 months. These data emphasized the importance of close follow-up in the first two years after surgery.

Recurrence and outcomes of non‐functional pancreatic neuroendocrine tumours post‐resection: an Australian retrospective, multicentre cohort study

“…Table 4 highlights differences in characteristics and outcomes of resected PNETs in this cohort compared to two large, independent trials conducted in USA and Europe. 6,9 Overall, the Australian cohort had lower grades and recurrences but higher operative complications.…”

“…The median length of hospital stay was 10 days. Forty-four patients required ICU admission post-operatively with a median length of stay of 2 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

“…Despite the increasing prevalence of PNETs in Australia, information about their post‐operative outcomes is scarce 4 . Post‐operative morbidity and subsequent recurrence rates are highly variable in the literature, 5–8 and may differ between countries due to various factors including population characteristics or surgical techniques 9 . Therefore, it is important to develop guidelines to facilitate appropriate clinical or surgical management for the Australian population.…”

Consensus on the clinical diagnosis and treatment of grade 3 pancreatic neuroendocrine tumors

“…pNET with highrisk factors can experience recurrence or metastasis within 16 to 18 months after surgery. [72][73][74][75][76] Therefore, some studies suggested shortening the follow-up interval or providing adjuvant therapy for pNET patients with high-risk factors. However, Barret et al [77] found that neither SSA nor cytotoxic adjuvant chemotherapy provided benefits to patients with gastrointestinal pancreatic NETs after radical resection.…”

Preoperative prediction of lymph node metastasis in nonfunctioning pancreatic neuroendocrine tumors from clinical and MRI features: a multicenter study

“…Nonfunctioning PNETs (NF‑PNETs) are much more common than functioning PNETs, account for approximately 70–90% of all PNETs [ 5 ]. NF‑PNETs are associated with heterogeneous biological behaviors ranging from indolent to highly aggressive [ 6 ]. The clinical outcomes are variable with the 5-year survival rates ranging from 30 to 66% [ 7 ].…”