Lymph node ratio, but not the total number of examined lymph nodes or lymph node metastasis, is a predictor of overall survival for pancreatic neuroendocrine neoplasms after surgical resection

Liu, Peng; Zhang, Xianbin; Shang, Yongpeng; Lu, Lixuan; Cao, Fei; Sun, Min; Tang, Zhaohui; Vollmar, Brigitte; Gong, Peng

doi:10.18632/oncotarget.19184

Cited by 21 publications

(18 citation statements)

References 41 publications

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“…Except the TNM staging system, there are a plethora of other indicators for the prognosis of pNET patients. Through our analysis, the grade, surgery, age and sex were independent predictors for OS, consistent to the previous reports 27 , 32 . Grade reflected tumor biological behavior and was closely connected to its prognosis 33 .…”

Section: Discussionsupporting

confidence: 91%

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The latest exploration of staging and prognostic classification for pancreatic neuroendocrine tumors: a large population-based study

Gao

Liu

et al. 2018

J. Cancer

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Background: A modified European Neuroendocrine Tumor Society (mENETS) staging system has been confirmed to be more suitable for pancreatic neuroendocrine tumors (pNETs) when compared to the American Joint Committee on Cancer (AJCC) or the European Neuroendocrine Tumor Society (ENETS) systems in the last few years. However, the importance of N stage has been recently published with several significant updates.Methods: SEER registry (n = 2,209) was used to evaluate the application of the AJCC 7th staging system, ENETS staging system, mENETS staging system and reformed ENETS (rENETS) staging system in this study.Results: For the ENETS staging system, patients with stage I disease had a similar prognosis to patients with stage II disease (P=0.154), and patients with stage IIIA and stage IIIB diseases showed adverse prognostic potential. The proportion of patients with stage III diseases using AJCC 7th staging system was extremely lower than those with mENETS staging system or rENETS staging system (3.6%, 23.0% and 23.7%, respectively). Furthermore, the hazard ratio of death for patients with stage II or III disease using rENETS staging system was slightly higher than that of mENETS staging system. Besides, survival curves were better separated by rENETS staging system. A prognostic nomogram for overall survival (OS) was formulated to obtain superior discriminatory abilities.Conclusions: The rENETS staging system has superior distribution in proportion than the AJCC 7th, ENETS or mENETS staging system, and one more accurate and advanced predictive model will be achieved via the incorporation to be adopted in clinical practice.

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Section: Discussionsupporting

confidence: 91%

“…Controversy still remains on whether the patients' survival is related to lymph node metastasis 24 - 27 . Although Krampit et al 25 had considered the links between the number of lymph nodes and survival, he just applied two lymph nodes as the cut-off value, which was limited and blurry.…”

Section: Discussionmentioning

confidence: 99%

The latest exploration of staging and prognostic classification for pancreatic neuroendocrine tumors: a large population-based study

Gao

Liu

et al. 2018

J. Cancer

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“…On the other hand, the multivariate analysis demonstrated that LN metastases were not an independent prognostic factor for patients (Table ). A similar result was also found in Peng's study, and they demonstrated that an LN‐positive ratio greater than 0.4 was an independent risk factor for pancreatic NENs . Therefore, the LN‐positive ratio may be a strong predictive factor for identifying high‐risk patients.…”

Section: Discussionsupporting

confidence: 83%

Resection of the primary tumor improves survival in patients with gastro‐entero‐pancreatic neuroendocrine neoplasms with liver metastases: A SEER‐based analysis

Zheng

et al. 2019

Cancer Medicine

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Patients who suffer from gastro‐entero‐pancreatic neuroendocrine neoplasms (GEP‐NENs) often present with liver metastatic disease. The efficacy of primary tumor resection (PTR) for these patients remains controversial due to the relatively heterogeneous behavior of the primary tumor and the lack of clinical evidence. In this series, GEP‐NEN patients with liver metastases (LM) were selected from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. A logistic regression model was used to analyze variables that were associated with PTR. A Cox proportional hazards model was used to identify independent prognostic risk factors. In total, 1547 patients were enrolled in our study, including 897 patients who underwent PTR. Resection of the primary tumor was associated with prolonged survival in all patients (5‐year overall survival (OS) rates: 57.0% vs 15.4%, P < .001), and improved 5‐year OS rates were observed in patients with gastric, small intestinal, colorectal, and pancreatic subtypes (39.7%, 73.3%, 24.6%, and 59.7%, respectively). On the multivariate analysis, PTR was an independent prognostic factor of prolonged OS (HR = 0.48, 95% CI: 0.39‐0.59, P < .001). Patients with a young age (≤60 years), small intestinal or colorectal NENs, a large primary tumor, lymph node (LN) metastases, and high tumor differentiation were more likely to undergo PTR. However, patients with colorectal NENs or a large primary tumor (≥4 cm) were at an increased risk of death independently in the PTR subgroup. The risk factors for OS also included old age, gastric tumor location, and poor differentiation. In conclusion, although PTR prolonged OS in all GEP‐NEN patients presenting with LM, surgical recipients should be considered carefully. Age, primary tumor site, size, and differentiation might help surgeons identify patients who could benefit from PTR.

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“…However, the minimum number of TLN examined in PD is controversial. The AJCC staging system recommends at least 12 harvested nodes for accurate staging because insufficient LNs may lead to under-stage the N category in many kinds of tumors, such as gastric carcinoma or pancreatic carcinoma 1 , 17 - 20 . In some studies, the overall number of TLN was relatively small when PD was performed 11 , 12 .…”

Section: Introductionmentioning

confidence: 99%

Surgical management of periampullary adenocarcinoma: defining an optimal prognostic lymph node stratification schema

Mao

Wang

et al. 2018

J. Cancer

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Background: Lymph node (LN) metastasis is a strong predictor of unfavorable prognosis for patients with periampullary adenocarcinoma after surgical resection. We sought to assess the prognostic performance of several LN staging systems, including American Joint Committee on Cancer (AJCC)/ International Union Against Cancer (7th edition) N stage, the total number of LN (TLN), the number of metastatic LN (MLN), the lymph node ratio (LNR) and the log odds of MLNs (LODDS), in patients with periampullary adenocarcinoma after surgical resection and identify the optional LN staging system to accurately stratify patients with different prognoses.Methods: We retrospectively analyzed 205 patients with periampullary adenocarcinoma after surgical resection. The predictive effects of several LN staging systems on overall survival (OS) and progression free survival (PFS) for all included patients and patients with more than 12 TLNs examined were evaluated and compared using the time-dependent receive operating characteristic (ROC) curve and decision curve analysis (DCA), respectively.Results: Eighty-nine patients (43.4%) had LN metastasis and their survival was not significantly decreased compared with patients without LN metastasis. LODDS and LNR were able to stratify patients into various subgroups with significant differences of both OS and PFS. When assessed using ROC curve and DCA, LODDS outperformed LNR and other LN staging systems in predicting OS and PFS. In addition, when analyzed in patients with more than 12 TLNs examined, LODDS had a higher value of area under ROC curve (AUC) and showed better performance of DCA.Conclusion: LODDS performs better than other LN staging systems in predicting OS and PFS for patients with periampullary adenocarcinoma after surgical resection. Adequate LN dissection is necessary for curative surgery, as well as to achieve a more accurate staging of the disease and a more precise prediction of survival for these patients.

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Lymph node ratio, but not the total number of examined lymph nodes or lymph node metastasis, is a predictor of overall survival for pancreatic neuroendocrine neoplasms after surgical resection

Cited by 21 publications

References 41 publications

The latest exploration of staging and prognostic classification for pancreatic neuroendocrine tumors: a large population-based study

The latest exploration of staging and prognostic classification for pancreatic neuroendocrine tumors: a large population-based study

Resection of the primary tumor improves survival in patients with gastro‐entero‐pancreatic neuroendocrine neoplasms with liver metastases: A SEER‐based analysis

Surgical management of periampullary adenocarcinoma: defining an optimal prognostic lymph node stratification schema

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