Prognostic factors after resection of locally advanced non-functional pancreatic neuroendocrine neoplasm: an analysis from the German Cancer Registry Group of the Society of German Tumor Centers

Abstract

Objective The available literature regarding outcome after pancreatic resection in locally advanced non-functional pNEN (LA-pNEN) is sparse. Therefore, this study evaluates the current survival outcomes and prognostic factors in after resection of LA-pNEN. Materials and methods This population-based analysis was derived from 17 German cancer registries from 2000 to 2019. Patients with upfront resected non-functional non-metastatic LA-pNEN were included. Results Out of 2776 patients with pNEN, 277 met the inclusion criteria. 137 (45%) of the patients were female. The median age was 63 ± 18 years. Lymph node metastasis was present in 45%. G1, G2 and G3 pNEN were found in 39%, 47% and 14% of the patients, respectively. Resection of LA-pNEN resulted in favorable 3-, 5- and 10-year overall survival of 79%, 74%, and 47%. Positive resection margin was the only potentially modifiable independent prognostic factor for overall survival (HR 1.93, 95% CI 1.71–3.69, p value = 0.046), whereas tumor grade G3 (HR 5.26, 95% CI 2.09–13.25, p value < 0.001) and lymphangiosis (HR 2.35, 95% CI 1.20–4.59, p value = 0.012) were the only independent prognostic factors for disease-free survival. Conclusion Resection of LA-pNEN is feasible and associated with favorable overall survival. G1 LA-pNEN with negative resection margins and absence of lymph node metastasis and lymphangiosis might be considered as cured, while those not fulfilling these criteria might be considered as a high-risk group for disease progression. Herein, negative resection margins represent the only potentially modifiable prognostic factor in LA-pNEN but seem to be influenced by tumor grade.

The extent of androgen receptor and HER2 expression allows for targeted therapy in most cases of salivary duct carcinoma: analysis of clinical and histopathological data in a tertiary care center

“…Various independent negative prognostic factors on OS and/or DFS such as higher age, male gender, higher T/N stage, extracapsular spread, perineural invasion, facial nerve palsy, and postoperative radiation therapy have been identified in different studies [ 3 , 16 , 19 , 23 , 24 ]. This study is the first to reveal the independent negative prognostic influence of positive margins on DFS in SDC (HR = 4.0, p = 0.03), which seems plausible and has been proven for various other solid cancer entities [ 25 – 27 ]. Nevertheless, this result has to be emphasized as the surgical therapy of an SDC in the parotid gland poses a particular challenge due to the anatomical proximity to functionally relevant structures such as the facial nerve.…”

When Should Lymphadenectomy Be Performed in Non-Metastatic Pancreatic Neuroendocrine Tumors? A Population-Based Analysis of the German Clinical Cancer Registry Group

“…Moreover, we observed an exponential shift in the distribution of tumor grade in tumors larger than 2 cm. While T1 tumors were 80% G1, T2 tumors were mostly (53%) G2/G3, which in turn is also a poor prognostic factor for DFS and OS in pNETs [13,22,23].…”

“…First, the presence of LNM was not associated with overall survival (OS); however, LNM represented an independent prognostic variable for disease-free survival (DFS), which is a more valid parameter considering the indolent biology of pNETs [13]. Over the years, the association of LNM with oncological outcomes has been controversial.…”

Multivisceral resection of nonfunctional pancreatic neuroendocrine neoplasm with nearby organ invasion: a case report

“…It is worth noting that there is ongoing debate among surgeons on the survival and symptomatic benefits of surgery for patients with locally advanced and metastatic pNENs, particularly G3 pNETs and pNECs ( 6 ). The survival advantages and symptom improvement brought by surgery may be superior to systemic comprehensive treatment, according to increasing amounts of evidence ( 7 – 11 ). This unquestionably serves as a compelling reason for doctors to determine whether to have surgery, even while the procedure is still scheduled.…”