Risk of preoperative understaging of duodenal neuroendocrine neoplasms: a plea for caution in the treatment strategy

Rossi, Roberta; Milanetto, Anna Caterina; Andreasi, Valentina; Campana, Davide; Coppa, Jorgelina; Nappo, Gennaro; Rinzivillo, Maria; Invernizzi, Pietro; Modica, Roberta; David, Alina; Partelli, Stefano; Mazzaferro, Vincenzo; Zerbi, Alessandro; Panzuto, Francesco; Pasquali, Claudio; Falconi, Massimo; Massironi, Sara

doi:10.1007/s40618-021-01528-1

Cited by 20 publications

(12 citation statements)

References 39 publications

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“…Minor papilla-ampulla NETs were staged using the same criteria adopted by AJCC for major ampulla NETs, as following: pT1 (tumor dimension ≤ 1 cm and confined within the sphincter), pT2 (tumor invades through sphincter into duodenal submucosa or muscularis propria, or is > 1 cm), pT3 (tumor invades the pancreas or peripancreatic adipose tissue), and pT4 (tumor invades the visceral peritoneum (serosa) or other organs). N stage was assigned only in cases which underwent surgical lymphadenectomy (pN stage); radiological N stage was not assigned in consideration of the high likelihood of understaging with imaging/preoperative techniques observed in this setting [28].…”

Section: Methodsmentioning

confidence: 99%

Ampullary Neuroendocrine Neoplasms: Identification of Prognostic Factors in a Multicentric Series of 119 Cases

et al. 2022

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Neuroendocrine neoplasms (NENs) of the major and minor ampulla are rare diseases with clinico-pathologic features distinct from non-ampullary-duodenal NENs. However, they have been often combined and the knowledge on prognostic factors specific to ampullary NENs (Amp-NENs) is limited. The aim of this study was to identify factors associated with metastatic potential and patient prognosis in Amp-NENs. We clinically and histologically investigated an international series of 119 Amp-NENs, comprising 93 ampullary neuroendocrine tumors (Amp-NETs) and 26 neuroendocrine carcinomas (Amp-NECs). Somatostatin-producing tubulo-acinar NET represented the predominant Amp-NET histologic subtype (58 cases, 62%, 12 associated with type 1 neurofibromatosis). Compared to Amp-NETs, Amp-NECs arose in significantly older patients and showed a larger tumor size, a more frequent small vessel invasion, a deeper level of invasion and a higher rate of distant metastasis, and, importantly, a tremendously worse disease-specific patient survival. In Amp-NETs, the WHO grade proved to be a strong predictor of disease-specific survival (hazard ratio: 12.61, p < 0.001 for G2 vs G1), as well as patient age at diagnosis > 60 years, small vessel invasion, pancreatic invasion, and distant metastasis at diagnosis. Although nodal metastatic disease was not associated with survival by itself, patients with > 3 metastatic lymph nodes showed a worse outcome in comparison with the remaining Amp-NET cases with lymphadenectomy. Tumor epicenter in the major ampulla, small vessel invasion, and tumor size > 16 mm were independent predictors of nodal metastases in Amp-NETs. In conclusion, we identified prognostic factors, which may eventually help guide treatment decisions in Amp-NENs.

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Section: Methodsmentioning

confidence: 99%

Ampullary Neuroendocrine Neoplasms: Identification of Prognostic Factors in a Multicentric Series of 119 Cases

et al. 2022

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“…Endoscopic resection is increasingly performed instead of surgery. However, duodenal NENs are characterized by a highly variable prognosis and, despite the small size, can be metastatic in up to 55% of cases, either at diagnosis or thereafter [20]; additionally, considered that conventional imaging has a poor detection rate for loco-regional nodes and micro-metastases in the presurgical setting, the choice of local conservative approaches, including endoscopy or local surgical excision, should be carefully balanced and discussed by a multidisciplinary team and EUS should always be included in the preoperative phase for a more accurate local staging [21]. Rectal NENs have shown a dramatic increase in their incidence, as they are more and more frequently incidentally found during screening colonoscopies.…”

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confidence: 99%

The Increasing Incidence of Neuroendocrine Neoplasms Worldwide: Current Knowledge and Open Issues

Rossi

Massironi

2022

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“…It is might because the anatomical location and anatomical characteristics of the gallbladder made the gallbladder NEN more prone to invasion and infiltration of the liver and its surrounding structures, and gallbladder NEN was often diagnosed at a late stage in its course due to occult symptoms [ 23 ], while the AOV or EBD NEN was more likely to induce clinical symptoms like jaundice, making it possibly discovered and diagnosed at the early stage [ 24 ]. Therefore, cultivating good health awareness, regular health checkups, and the application of more precise diagnostic techniques could increase the early diagnosis rate of gallbladder NEN, thereby improving the prognosis of patients with gallbladder NEN [ 25 ]. Besides, the biological characteristics of NEN could vary with the location of the tumor, which might cause differences among the prognosis of the gallbladder, AOV, and EBD NENs.…”

Section: Discussionmentioning

confidence: 99%

The clinical and prognostic factors for biliary neuroendocrine neoplasm: a study based on the SEER database

et al. 2022

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Background In this study, we aimed at elucidating the postoperative survival and prognostic factors in patients with biliary neuroendocrine neoplasm (NEN). Methods Cases of biliary system NEN and adenocarcinoma from 1975 to 2016 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A propensity score matching (PSM) method was used to adjust baseline differences in clinicopathological characteristics in our analysis. The Kaplan–Meier analysis was carried out for survival analysis. Results A total of 233 patients with biliary system NEN were enrolled in this study, of which 119 patients’ lesions located in gallbladder, while the others’ located in bile duct. The postoperative overall survival of bile duct NEN is significantly longer than that of gallbladder NEN (P < 0.001). For gallbladder NENs, surgery method (P = 0.020) and lymph node metastasis (P = 0.018) were identified as independent prognostic factors. In terms of ampulla of vater (AOV) NENs, age (P = 0.017) and lymph node metastasis (P = 0.006) were identified as independent prognostic factors, while grade (P = 0.002) and lymph node metastasis (P = 0.036) were identified as independent prognostic factors for extrahepatic bile duct (EBD) NENs. PSM analysis indicated that patients with biliary duct NENs have a better postoperative prognosis than biliary duct adenocarcinoma. Conclusions Patients with NEN have better overall survival than patients with adenocarcinoma. Gallbladder NEN has an adverse prognosis than that of biliary tract NEN. The pathological subtype, differentiation, lymph node metastasis, surgery method, and lymph node resection could affect the postoperative prognosis of the gallbladder and biliary tract NEN.

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Risk of preoperative understaging of duodenal neuroendocrine neoplasms: a plea for caution in the treatment strategy

Cited by 20 publications

References 39 publications

Ampullary Neuroendocrine Neoplasms: Identification of Prognostic Factors in a Multicentric Series of 119 Cases

Ampullary Neuroendocrine Neoplasms: Identification of Prognostic Factors in a Multicentric Series of 119 Cases

The Increasing Incidence of Neuroendocrine Neoplasms Worldwide: Current Knowledge and Open Issues

The clinical and prognostic factors for biliary neuroendocrine neoplasm: a study based on the SEER database

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