Predicting aggressive behavior in nonfunctioning pancreatic neuroendocrine tumors

Cherenfant, Jovenel; Stocker, Susan J.; Gage, Mistry K.; Du, Hongwu; Thurow, Tiffany A.; Odeleye, Melanie; Schimpke, Scott; Kaul, Karen L.; Hall, Curtis R.; Lamzabi, Ihab; Gattuso, Paolo; Winchester, David J.; Marsh, Robert W.; Roggin, Kevin K.; Bentrem, David J.; Baker, Marshall S.; Prinz, Richard A.; Talamonti, Mark S.

doi:10.1016/j.surg.2013.07.004

Cited by 119 publications

(75 citation statements)

References 21 publications

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“…Moreover, extensive use of cross-sectional imaging has led to an increased prevalence of small nf-pan-NENs, for which treatment based on surgical resection or follow-up remains a matter of debate. Although most pan-NENs have a good prognosis after surgical resection [27, 28], studies regarding the risk of tumor recurrence and their potential predictors are needed to plan the most cost-effective follow-up and to assess which patients actually need an adjuvant treatment. This study provided an overview on pan-NEN recurrence in a large cohort of patients resected at a single high-volume center with a median follow-up of more than 5 years.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where?

et al. 2018

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Background/Aims: Pancreatic neuroendocrine tumors (pan-NENs) represent an increasingly common indication for pancreatic resection, but there are few data regarding possible recurrence after surgery. The aim of the study was to describe the frequency, timing, and patterns of recurrence after resection for pan-NENs with consequent implications for postoperative follow-up. Methods: We performed a retrospective analysis of pan-NENs resected between 1990 and 2015 at The Pancreas Institute, University of Verona Hospital Trust. Predictors of recurrence were assessed. Survival analysis was conducted using the Kaplan-Meier and conditional survival (CS) methods. Results: The cohort consisted of 487 patients with a median follow-up of 71 months. Recurrence developed in 12.3%: 54 (11.1%) liver metastases, 11 (2.3%) local recurrence, 10 (2.1%) nodal recurrence, and 8 (1.6%) metastases in other organs. Thirty-one (6.4%) died due to disease recurrence. Size > 21 mm, G3 grade, nodal metastasis, and vascular infiltration were independent predictors of overall recurrence. Recurrence occurred either during the first year of follow-up (n = 9), or after 10 years (n = 4). CS analysis revealed that nonfunctioning G1 pan-NEN ≤20 mm without nodal metastasis or vascular invasion had a negligible risk of developing recurrence. In the present series, after 5 years of follow-up without developing recurrence, tumor recurrence occurred only in the form of liver metastases. Conclusions: Recurrence of pan-NENs is rare and is predicted by tumor size, nodal metastasis, grading, and vascular invasion. Patients with G1 pan-NEN without nodal metastasis and vascular invasion may be considered cured by surgery. After 5 years without recurrence, follow-up should focus on excluding the development of liver metastases.

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Section: Discussionmentioning

confidence: 99%

Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where?

et al. 2018

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“…Nonfunctional tumors were classified as "symptomatic" when patients presented with symptoms related to tumor mass prompting abdominal CT or MRI. Patients who presented as a result of unrelated conditions were classified as having "incidental" tumors or "incidentalomas" (9).…”

Section: Methodsmentioning

confidence: 99%

A single institutions 21-year experience with surgically resected pancreatic neuroendocrine tumors: an analysis of survival and prognostic factors

et al. 2016

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Background: Pancreatic neuroendocrine tumors (pNETs) comprise a heterogeneous group of tumors with a varied biological behavior. In the present study, we analyzed the experience of 79 pNETs resected between 1993 and 2015. The pathologic prognostic factors (European Neuroendocrine Tumor Society, ENETS; and AJCC) classification, vascular invasion (VI), proliferation index (ki-67) and the presence of necrosis were retrospectively reviewed.Methods: The clinical data of 79 patients with pNETs who underwent surgery were retrospectively analyzed. Mortality rates and Kaplan-Meier estimates were used to evaluate survival over time for pathologic stages, tumor functionality, and vascular invasion. Cox proportional hazards models were used to calculate the hazard ratio regarding ENETS, AJCC staging, sex, tumor functionality and vascular invasion.Results: The male:female ratio was 40:39. Twenty-one patients (26%) had functional tumors and 58 (73.4%) had nonfunctional tumors, of which 35 (44.3%) were diagnosed incidentally. Seventeen Whipple procedures, 46 distal pancreatectomies (including 26 laparoscopic and 20 open procedures), 8 laparoscopic central pancreatectomies, 1 laparoscopic resection of the uncinated process and 7 enucleations (one laparoscopic) were performed. Vascular invasion and necrosis were observed in 29 of 75 cases (38.6%) and in 16 cases (29%), respectively. The comparison between survivor functions of ENETS staging categories showed statistically significant differences (p = 0.042). Mortality rate was higher in patients with non-functioning tumors compared with hormonally functioning tumors (p = 0.052) and in those with vascular invasion (p = 0.186).Conclusions: In spite of the heterogeneity of pNETs, the ENETS TNM classification efficiently predicts long-term prognosis. The non-functioning tumors and the presence of vascular invasion are associated with poor prognosis.

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“…Cox proportional hazard and ratios analysis of 128 non-functional PNETs identified patient age >55years, grade 3 histology, and distant metastases as prognostic features; gender, race, BMI, symptoms, lymphovascular and perineural invasion, and size were not related to metastases or survival [111]. The 5-year survival rate is reported at 65%, with 45% surviving at 10 years [27].…”

Section: Non-functional Pnetsmentioning

confidence: 99%

Pancreatic Neuroendocrine Tumors in the 21<sup>st</sup> Century—An Update

Kanthan¹,

Senger²,

Ahmed³

et al. 2017

JCT

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Pancreatic neuroendocrine tumors (PNETs) are rare, reported to account for less than 1% -2% of all pancreatic tumors. This, however, is likely an underestimation, as improved radiologic techniques and heightened awareness have resulted in an increase in the detection of incidentalomas, with estimations of true prevalence as high as 10%. The term "PNET" is an umbrella name that encompasses a heterogeneous group of neoplasms each with distinct clinical presentations, diagnostic radiographic features, management principles, and tumor/patient outcomes. In this context, accurate diagnosis is challenging, and management guidelines remain unclear. A high degree of clinical suspicion is required for best patient management. This manuscript provides an update on PNETs in the 21 st century, in which we re-examine the terminology, epidemiology, classification, etiopathogenesis, radiographic and histopathologic diagnostic features, management for localized and metastatic disease, as well as a review of features defining functional and non-functional PNETS, and finally deliberates on the prognosis and predictive features of this unpredictable and largely unfathomable neoplasm.

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Predicting aggressive behavior in nonfunctioning pancreatic neuroendocrine tumors

Cited by 119 publications

References 21 publications

Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where?

Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where?

A single institutions 21-year experience with surgically resected pancreatic neuroendocrine tumors: an analysis of survival and prognostic factors

Pancreatic Neuroendocrine Tumors in the 21<sup>st</sup> Century—An Update

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Predicting aggressive behavior in nonfunctioning pancreatic neuroendocrine tumors

Cited by 119 publications

References 21 publications

Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where?

Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where?

A single institutions 21-year experience with surgically resected pancreatic neuroendocrine tumors: an analysis of survival and prognostic factors

Pancreatic Neuroendocrine Tumors in the 21&lt;sup&gt;st&lt;/sup&gt; Century—An Update

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A single institutions 21-year experience with surgically resected pancreatic neuroendocrine tumors: an analysis of survival and prognostic factors

Pancreatic Neuroendocrine Tumors in the 21<sup>st</sup> Century—An Update