Pancreatic neuroendocrine tumors

Hill, Joshua S.; McPhee, James T.; McDade, Theodore P.; Zhou, Zheng; Sullivan, Mary; Whalen, Giles F.; Tseng, Jennifer F.

doi:10.1002/cncr.24065

Cited by 271 publications

(83 citation statements)

References 31 publications

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“…The site of primary NETs has been identified as an important prognostic feature of NETs in previous studies [15,16]. NETs are diverse in their site of origin and clinical behavior, and researchers have found that pancreatic primary tumor localization is a risk factor for decreased survival [17,18,19,20]. A comparison of P-NETs and GE-NETs exhibited higher NLR and PLR levels in patients with P-NETs, which was statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of the Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Patients with Neuroendocrine Tumors: An Izmir Oncology Group Study

Salman

Kazaz²,

Varol

et al. 2016

Chemotherapy

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Background: Several studies evaluating the prognostic factors of gastrointestinal and pancreatic neuroendocrine tumors (GEP-NETs) have been published. The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been accepted as prognostic factors for cancer patients. Materials and Methods: This study included 132 patients diagnosed with GEP-NETs. Peripheral blood samples were collected before the pretreatment period. Results: NLR and PLR were increased as the grade increased in NETs. The embryonic origin analysis revealed higher NLR and PLR rates in NETs of foregut origin. NLR and PLR were also higher in pancreatic NET patients compared to the gastroenteric NET patients. Analysis of NETs by TNM indicated that an advanced stage was accompanied by significantly higher NLR and PLR. We found a strong negative correlation between progression-free survival and NLR and PLR. Conclusion: The study verified that NLR and PLR are simple laboratory findings that can be used to identify NETs with a worse outcome.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of the Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Patients with Neuroendocrine Tumors: An Izmir Oncology Group Study

Salman

Kazaz²,

Varol

et al. 2016

Chemotherapy

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“…Hill et al demonstrated that surgical resection was associated with improved survival for patients with localized, regional, or metastatic PNETs. 21 However, they did not examine the subset of patients with nonfunctional tumors ≤2 cm. The benefit of surgery in this population is controversial.…”

Section: Discussionmentioning

confidence: 99%

Impact of Extent of Surgery on Survival in Patients with Small Nonfunctional Pancreatic Neuroendocrine Tumors in the United States

et al. 2014

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Background Nonfunctional pancreatic neuroendocrine tumors (PNETs) ≤2 cm have uncertain malignant potential, and optimal treatment remains unclear. Objectives of this study were to better understand their malignant potential, determine whether extent of surgery or lymph node dissection is associated with overall survival (OS), and identify other factors associated with OS. Methods Patients with nonfunctional PNETs ≤2 cm were identified from the National Cancer Data Base (1998 to 2011). Descriptive statistics were used for patient characteristics and surgical resection patterns. Five-year OS was estimated using Kaplan–Meier analyses across extent of surgery and compared using the log-rank test. Cox proportional regression modeling was used to test the association between survival and extent of surgery. Results A total of 1854 patients with nonfunctional PNETs ≤2 cm were included. From 1998 to 2011, these tumors increased three-fold as a proportion of all PNETs. Among tumors ≤0.5 cm, 33 % presented with regional lymph node metastases and 11 % with distant metastases. Five-year OS for patients not undergoing surgery was 27.6 % vs. 83.0 % for partial pancreatectomy, 72.3 % for pancreaticoduodenectomy, and 86.0 % for total pancreatectomy (p< 0.01). Multivariate analysis demonstrated no difference in OS based on type of surgery or the addition of regional lymphadenectomy (p = 0.16). Younger age and later year of diagnosis were independently associated with improved survival. Conclusions Small nonfunctional PNETs represent an increasing proportion of all PNETs and have a significant risk of malignancy. Survival is improving over time despite older age at diagnosis. Type of surgical resection and the addition of lymph node resection were not associated with OS.

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“…[16,36,35] Even when liver metastases cannot be completely resected, retrospective studies suggest that resection of the primary tumor prolongs survival of patients with SBNETs and PNETs. [13,16,15,36,14] Knowing with high positive predictive value that an unknown metastasis arose from an SBNET primary therefore presents a strong indication for surgical exploration. A criticism of using such an algorithm for surgical planning is that because most PNETs are visualized on CT imaging, unknown-primary NETs are already likely to be of small bowel origin.…”

Section: Discussionmentioning

confidence: 99%

Gene expression accurately distinguishes liver metastases of small bowel and pancreas neuroendocrine tumors

Sherman

Maxwell

Carr

et al. 2014

Clin Exp Metastasis

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Small bowel (SBNETs) and pancreatic neuroendocrine tumors (PNETs) often present with liver metastases. Although liver biopsy establishes a neuroendocrine diagnosis, the primary tumor site is frequently unknown without exploratory surgery. Gene expression differences in metastases may distinguish primary SBNETs and PNETs. This study sought to determine expression differences of four genes in neuroendocrine metastases and to create a gene expression algorithm to distinguish the primary site. Nodal and liver metastases from SBNETs and PNETs (n=136) were collected at surgery under an Institutional Review Board-approved protocol. Quantitative PCR measured expression of bombesin-like receptor-3, opioid receptor kappa-1, oxytocin receptor, and secretin receptor in metastases. Logistic regression models defined an algorithm predicting the primary tumor site. Models were developed on a training set of 21 nodal metastases and performance was validated on an independent set of nodal and liver metastases. Expression of all four genes was significantly different in SBNET compared to PNET metastases. The optimal model employed expression of bombesin-like receptor-3 and opioid receptor kappa-1. When these genes did not amplify, the algorithm used oxytocin receptor and secretin receptor expression, which allowed classification of all 136 metastases with 94.1% accuracy. In the independent liver metastasis validation set, 52/56 (92.9%) were correctly classified. Positive predictive values were 92.5% for SBNETs and 93.8% for PNETs. This validated algorithm accurately distinguishes SBNET and PNET metastases based on their expression of four genes. High accuracy in liver metastases demonstrates applicability to the clinical setting. Studies assessing this algorithm’s utility in prospective clinical decision-making are warranted.

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Pancreatic neuroendocrine tumors

Cited by 271 publications

References 31 publications

Prognostic Value of the Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Patients with Neuroendocrine Tumors: An Izmir Oncology Group Study

Prognostic Value of the Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Patients with Neuroendocrine Tumors: An Izmir Oncology Group Study

Impact of Extent of Surgery on Survival in Patients with Small Nonfunctional Pancreatic Neuroendocrine Tumors in the United States

Gene expression accurately distinguishes liver metastases of small bowel and pancreas neuroendocrine tumors

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