Predicting survival in non‐functional pancreatic neuroendocrine tumours

Tan, Qingquan; Wang, Xing; Yang, Le; Chen, Yonghua; Tan, Chunlu; Ke, Nengwen

doi:10.1111/ans.16072

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…Unfortunately, most studies investigating vascular/lymphovascular invasion as prognostic factors in resected PanNETs neither specified nor separated venous invasion from small vessel invasion. The results from these studies were not very consistent 19–32. While most studies showed that lymphovascular/vascular invasion were associated with recurrence-free survival only in univariate analysis,23,25,27,28,31,32 a number of other studies demonstrated either significant association with recurrence-free survival in multivariate analysis with a hazard ration ranging from 2.8 to 6.5,19,22,29,30 or no prognostic impact in all analyses 21,26.…”

Section: Discussionmentioning

confidence: 90%

“…The results from these studies were not very consistent 19–32. While most studies showed that lymphovascular/vascular invasion were associated with recurrence-free survival only in univariate analysis,23,25,27,28,31,32 a number of other studies demonstrated either significant association with recurrence-free survival in multivariate analysis with a hazard ration ranging from 2.8 to 6.5,19,22,29,30 or no prognostic impact in all analyses 21,26. The recurrence pattern was reported in some studies, with the liver being the most common site followed by regional lymph nodes 28,29.…”

Section: Discussionmentioning

confidence: 93%

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Venous Invasion in Pancreatic Neuroendocrine Tumors Is Independently Associated With Disease-free Survival and Overall Survival

Shi¹,

Chen²,

Davis³

et al. 2023

American Journal of Surgical Pathology

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In this study, we evaluated venous invasion and its association with survival in patients with resected pancreatic neuroendocrine tumor (PanNET). Surgical Pathology Archives were searched for pancreatectomies performed for PanNET between October 1, 2005, and December 31, 2019. Hematoxylin and eosin (H&E)-stained slides were evaluated for venous invasion, and Movat's stain was performed in all cases with no venous invasion detected on H&E stains. Pathology reports and electronic medical records were also reviewed. Venous invasion was identified in 23 of 145 (15.9%) cases on H&E stains, and Movat's stain identified additional 34 cases with venous invasion (39.3% overall). Orphan arteries with adjacent well-defined tumor nodules or subtle hyalinizing nodules in hyalinizing tumors are highly specific for venous invasion. In stage I-III cases (n = 122), venous invasion was associated with larger tumor size, higher World Health Organization (WHO) tumor grade, perineural invasion, extrapancreatic extension, lymph node metastasis, and liver metastasis (P < 0.05). In univariate analyses, tumor size, WHO grade, venous invasion, perineural invasion, T stage, and lymph node metastasis all correlated with disease-free survival; however, only venous invasion was associated with worse disease-free survival in multivariate analyses (P < 0.01). In all-stage cases, venous invasion was the only attributor associated with worse overall survival in multivariate analyses (P = 0.03). In summary, venous invasion in PanNET can be histologically subtle, and Movat's stain can greatly increase the detection rate. More importantly, enhanced venous invasion by Movat's stain correlates independently with disease-free survival in patients with stage I-III tumors and overall survival in allstage patients.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 93%

Venous Invasion in Pancreatic Neuroendocrine Tumors Is Independently Associated With Disease-free Survival and Overall Survival

Shi¹,

Chen²,

Davis³

et al. 2023

American Journal of Surgical Pathology

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“…Of all the assessed factors, tumor grade III–IV was most highly associated with LNM (OR 7.90), although the proportion of these patients was relatively low. Tumor grade has been considered the main determinant of the malignancy of NF-PNETs, which is associated with not only the metastasis potential ( 9 , 14 ) but also the long-term survival ( 15 , 24 ). With the support of developed image technology, fine-needle aspiration biopsy (guided by endoscopic ultrasound (EUS), US, or CT) is recommended to evaluate the tumor grade preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors of Small Non-Functional Pancreatic Neuroendocrine Tumors and the Risk of Lymph Node Metastasis: A Population-Level Study

Tan

Wang

et al. 2022

Front. Endocrinol.

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BackgroundSmall non-functional neuroendocrine tumors (NF-PNETs) are a heterogeneous subset of tumors with controversy regarding their optimal management. We aimed to analyze the prognostic factors of patients with small NF-PNETs and create a risk score for lymph node metastasis (LNM).MethodsData of 751 patients with NF-PNETs ≤ 2 cm were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate survival analysis was performed to analyze the prognostic factors. Logistic regression was used to identify risk factors for LNM.ResultsOf the 751 patients, 99 (13.2%) were confirmed to have LNM. In multivariate survival analysis, LNM (hazard ratio [HR], 2.12; 95% CI, 1.04–4.32, p = 0.040) was independently associated with disease-specific survival. Logistic regression identified that tumor location in the head of the pancreas (odds ratio [OR], 4.33; 95% CI, 2.75–6.81; p < 0.001), size ≥ 1.5–2 cm (OR, 1.84; 95% CI, 1.17–2.87; p = 0.009), and grade III–IV (OR, 7.90; 95% CI, 1.79–34.90; p = 0.006) were independent risk factors of LNM. According to the OR value, the risk of LNM was scored as follows: a score of 1 for tumors located in the body/tail of the pancreas and 4 for those located in the head; a score of 1 for tumors <1 cm and 2 for those ≥1.5–2 cm; and a score of 1 for tumors with grade I–II and 8 for those with grade III–IV. Finally, the median score for this cohort was 4, with an interquartile range of 3–6. Therefore, patients were classified as three groups based on the risk score system: a total score of 1–3 for low risk, 4–6 for intermediate risk (OR, 2.98; 95% CI, 1.59–5.60; p = 0.001), and 7–14 for high risk (OR, 8.94; 95% CI, 4.50–17.7; p < 0.001), with an incidence of LNM 5.0%, 13.5%, and 31.8%, respectively (p < 0.001).ConclusionSurgical resection with regional lymphadenectomy is recommended for small NF-PNETs with malignant potential of LNM. A risk score for LNM based on tumor grade, location, and size may preoperatively predict LNM of small NF-PNETs and guide clinical practice.

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“…Tumor grade is the crucial determinant of the biological aggressiveness of PNETs. Additionally, it is suggested to be associated with lymph node involvement ( 7 ), tumor recurrence ( 8 ), and overall prognosis ( 9 ). According to the 2010 World Health Organization (WHO) classification criteria ( 10 ), tumor grade is defined numerically by the proliferative indicator Ki-67, in which low-grade (grade 1 (G1)) tumors have a Ki-67 index from 0% to 2%, intermediate-grade (G2) tumors have a Ki-67 index from 3% to 20%, and high-grade (G3) tumors have a Ki-67 index greater than 20%.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Novel Radiomics-Based Nomogram With Machine Learning to Preoperatively Predict Histologic Grade in Pancreatic Neuroendocrine Tumors

et al. 2022

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BackgroudTumor grade is the determinant of the biological aggressiveness of pancreatic neuroendocrine tumors (PNETs) and the best current tool to help establish individualized therapeutic strategies. A noninvasive way to accurately predict the histology grade of PNETs preoperatively is urgently needed and extremely limited.MethodsThe models training and the construction of the radiomic signature were carried out separately in three-phase (plain, arterial, and venous) CT. Mann–Whitney U test and least absolute shrinkage and selection operator (LASSO) were applied for feature preselection and radiomic signature construction. SVM-linear models were trained by incorporating the radiomic signature with clinical characteristics. An optimal model was then chosen to build a nomogram.ResultsA total of 139 PNETs (including 83 in the training set and 56 in the independent validation set) were included in the present study. We build a model based on an eight-feature radiomic signature (group 1) to stratify PNET patients into grades 1 and 2/3 groups with an AUC of 0.911 (95% confidence intervals (CI), 0.908–0.914) and 0.837 (95% CI, 0.827–0.847) in the training and validation cohorts, respectively. The nomogram combining the radiomic signature of plain-phase CT with T stage and dilated main pancreatic duct (MPD)/bile duct (BD) (group 2) showed the best performance (training set: AUC = 0.919, 95% CI = 0.916–0.922; validation set: AUC = 0.875, 95% CI = 0.867–0.883).ConclusionsOur developed nomogram that integrates radiomic signature with clinical characteristics could be useful in predicting grades 1 and 2/3 PNETs preoperatively with powerful capability.

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Predicting survival in non‐functional pancreatic neuroendocrine tumours

Cited by 4 publications

References 19 publications

Venous Invasion in Pancreatic Neuroendocrine Tumors Is Independently Associated With Disease-free Survival and Overall Survival

Venous Invasion in Pancreatic Neuroendocrine Tumors Is Independently Associated With Disease-free Survival and Overall Survival

Prognostic Factors of Small Non-Functional Pancreatic Neuroendocrine Tumors and the Risk of Lymph Node Metastasis: A Population-Level Study

Development and Validation of a Novel Radiomics-Based Nomogram With Machine Learning to Preoperatively Predict Histologic Grade in Pancreatic Neuroendocrine Tumors

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