Metabolic Syndrome Is Associated with Impaired Survival after Surgery for Pancreatic Neuroendocrine Tumors

Abstract

Introduction: Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous group of neoplasms. Surgery is the only curative treatment option. However, our understanding of predictors of survival after surgery remains incomplete. The aim of the study was to evaluate metabolic syndrome (MetS) as a prognostic factor in pNET. Methods: In a retrospective single centre cohort study, we examined the influence of MetS in 120 patients with curative intended resection of pNETs on overall survival (OS), recurrence free survival (RFS) and outcome after recurrence. Results: MetS was present in 32 patients (26.6%). Patients with MetS had an impaired OS after curative intended surgery compared to patients without MetS (median OS 72 months (95% CI 13.3-130.7) vs not reached, p<0,001). The shortest survival was observed in patients with MetS in the presence of oligo-metastatic disease at time of surgery. In a multivariable Cox regression analysis MetS was identified as an independent risk factor for mortality (HR= 4.54 (95% CI (1.88- 11.00), p= 0.01). In our dataset, MetS was not associated with tumor recurrence or recurrence free survival. Nevertheless, in patients with recurrence, MetS was associated with shorter time to recurrence (median 3.4 months (95% CI (2.48-4.24) vs 20.1 months (95% CI (10.8-29.49), p<0.001), and poor outcome (HR=5.03 (95% CI (1.25-20.20), p= 0.01). Conclusions: We identified MetS as a negative prognostic factor after curative intended surgery for pNET. In particular, patients with oligo-metastatic disease might not benefit from extensive surgery in the presence of MetS. Furthermore, MetS had a strong impact on survival after recurrence.

Metformin and pancreatic neuroendocrine tumors: A systematic review and meta-analysis

“…As for the role of metformin, only five studies explored its role in the setting of pNET[ 17 , 27 , 29 , 32 , 37 ]. In detail, two studies reported the role of metformin in the insurgence of pNET[ 27 , 29 ], and the remaining three explored PFS, TFS, or OS[ 17 , 32 , 37 ].…”

Metabolic syndrome and cardiovascular disease in cancer survivors

“…Further, preceding studies indicated that co‐morbid metabolic syndrome potentially worsened clinical outcomes of cancer patients. 19 , 20 However, to date, data comparing the subsequent CVD risk between cancer patients with and without metabolic syndrome are scarce.…”

“…Although the prevalence was different depending on the cancer site, 17 metabolic syndrome was not a rare co‐morbidity among cancer survivors. Further, preceding studies indicated that co‐morbid metabolic syndrome potentially worsened clinical outcomes of cancer patients 19,20 . However, to date, data comparing the subsequent CVD risk between cancer patients with and without metabolic syndrome are scarce.…”

Metabolisches Syndrom und gastrointestinale Krebsvorsorge

“…MetS-Patienten haben aber nicht nur ein erhöhtes Krebsrisiko, sondern z. T. erkranken sie auch früher als Stoffwechselgesunde [16,17]. Das tumorspezifische 5-Jahres-Überleben von MetS-Patienten liegt unter dem von stoffwechselgesunden Tumorpatienten [18,19]. So geht das MetS mit einer bis 2,4-fach erhöhten Krebssterblichkeit einher [9,10,11].…”

“…Als zugrunde liegende Mechanismen werden insbesondere hormonelle und Wachstumsfaktoren (IGF-1, Insulin) angeschuldigt [64]. Bei Patienten mit resezierten, neuroendokrinen Pankreastumoren prognostiziert das MetS ein weniger günstiges Langzeit-Überleben [65]. Adenokarzinome der Speiseröhre und des Magens Das MetS erhöht das Risiko, an Adenokarzinomen der Speiseröhre, des ösophagogastralen Übergangs und der Magenkardia zu erkranken [66,67,68,69].…”