Surgical resection of high‐grade nonfunctional pancreatic neuroendocrine carcinoma is associated with improved survival

Jiang, Jerry; Park, Joon Y.; Kim, Stephanie; Daan, Amanda; Donahue, Timothy R.; Girgis, Mark D.

doi:10.1002/jso.26644

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…Subsequently, 2 retrospective analyses also supported the notion that palliative-intent resection of the primary tumor and/or radiation therapy may significantly improve survival for metastatic pNEC. In a retrospective analysis of patients with nonfunctioning pancreatic NECs of all stages, Jiang et al 29 observed that, in the metastatic setting, only surgical resection of the primary tumor (hazard ratio [HR], 0.18; P < 0.01) or chemotherapy improved survival outcomes for patients (HR, 0.56; P < 0.01). Furthermore, cause-specific survival after primary tumor resection was 15 months (interquartile range, 8–50) versus 5 months (interquartile range, 1–13; P < 0.01), regardless of whether patients received chemotherapy 29 .…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective analysis of patients with nonfunctioning pancreatic NECs of all stages, Jiang et al 29 observed that, in the metastatic setting, only surgical resection of the primary tumor (hazard ratio [HR], 0.18; P < 0.01) or chemotherapy improved survival outcomes for patients (HR, 0.56; P < 0.01). Furthermore, cause-specific survival after primary tumor resection was 15 months (interquartile range, 8–50) versus 5 months (interquartile range, 1–13; P < 0.01), regardless of whether patients received chemotherapy 29 . Feng et al 30 noted that the 50 of 350 patients (14.3%) who underwent resection of their pancreatic primary with or without metastasectomy and chemotherapy had significantly improved median overall survival compared with those who did not undergo surgery (12 vs 8 months, respectively; HR, 0.338 [95% confidence interval, 0.269–0.560]; P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

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Multidisciplinary Approach for the Management of Metastatic Poorly Differentiated Neuroendocrine Carcinoma of the Pancreas

Nakasone,

Bustillos,

Gui

et al. 2024

Pancreas

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Poorly differentiated pancreatic neuroendocrine carcinomas (pNECs) are rare, highly aggressive neoplasms. Frequently metastatic at diagnosis, prognosis is poor with median overall survival estimated to be less than 1 year. Although multidisciplinary management, including systemic medications and locoregional therapies aimed at reducing and preventing symptoms caused by mass effect, is the mainstay of treatment for patients with metastatic well-differentiated pancreatic neuroendocrine tumors, rapid progression, organ dysfunction, and poor performance status often preclude initiation of even single-modality palliative chemotherapy for patients with metastatic pNEC, limiting the use of and recommendation for multidisciplinary management. We describe the case of a 51-year-old male patient diagnosed with pNEC metastatic to liver and lymph nodes presenting with impending cholestatic liver failure for whom we were able to successfully initiate and dose-escalate cytotoxic chemotherapy with excellent radiographic response. After multidisciplinary review of his case, the patient underwent pancreaticoduodenectomy and hepatic wedge biopsies, with pathology demonstrating a pathologic complete response to chemotherapy in both the pancreas and liver. Surveillance scans at 2 years from initial diagnosis and 1 year from surgery remain without evidence of locoregional or distant recurrence, highlighting the importance and utility of multidisciplinary management in select cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Approach for the Management of Metastatic Poorly Differentiated Neuroendocrine Carcinoma of the Pancreas

Nakasone,

Bustillos,

Gui

et al. 2024

Pancreas

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“…Other literature argued that neuroendocrine tumors have been regarded as one of few tumor types in which debulking operation could still yield survival benefits in metastatic disease ( 22 , 23 ). Several previous studies have demonstrated the feasibility and safety of cancer-directed surgery in metastatic PanNET patients ( 24 , 25 ). However, these publications only included small sample sizes of patients or analyzed patients with various metastatic sites.…”

Section: Discussionmentioning

confidence: 99%

Survival Benefit of Surgical Resection for Pancreatic Neuroendocrine Tumors With Oligometastatic Liver Metastasis: A Retrospective and Propensity Score-Matching Analysis

Yang

Liu²,

Leng³

et al. 2022

Front. Oncol.

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BackgroundPancreatic neuroendocrine tumors (PanNETs) are a heterogeneous group of pancreatic malignancies. Surgical resection is the only curative treatment option for patients with localized PanNETs, yet the role of cancer-directed surgery (CDS) in the setting of oligometastatic liver metastasis remains a controversy.MethodsAll patients diagnosed with PanNETs and liver-only metastasis from 2010 to 2018 were identified from the SEER database. The biases of baseline characteristics between CDS and no-CDS cohorts were reduced by the propensity score-matching (PSM) method, and the prognostic role of CDS was estimated using the Kaplan–Meier method and Cox regression models. Logistic regression analysis was utilized to identify factors associated with patients who underwent CDS.ResultsA total of 1,270 PanNET patients with oligometastatic liver metastasis were included and analyzed. Of these patients, 283 (22.3%) patients underwent CDS of the primary tumor, while the remaining 987 (77.7%) did not. The OS and CSS were significantly better in the CDS cohort regardless of the propensity score analysis. Multivariate analysis revealed that age, tumor differentiation, tumor location, and lymph node status were significantly associated with patients who were more likely to receive CDS.ConclusionOur study demonstrated that CDS was associated with survival benefits in selected patients with PanNETs and liver-only metastasis based on a large population database.

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“…In contrast, a subset of patients presenting with local or locoregional disease may benefit from surgical excision with curative intent. 11,12 In these cases, it is essential that occult disease is ruled out with fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) staging and multidisciplinary discussion is also required. 13 Many patients will experience recurrence following surgery, with a retrospective analysis of data from 119 patients with pancreatic (Panc)-NECs reporting a median time to recurrence or metastasis of 7 months.…”

Section: Resectable Cases: Surgery With or Without Chemotherapymentioning

confidence: 99%

Future therapeutic strategies in the treatment of extrapulmonary neuroendocrine carcinoma: a review

et al. 2023

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Neuroendocrine neoplasms (NENs) are rare malignancies arising most commonly in the gastrointestinal and bronchopulmonary systems. Neuroendocrine carcinomas (NECs) are a subgroup of NENs characterised by aggressive tumour biology, poor differentiation and dismal prognosis. Most NEC primary lesions arise in the pulmonary system. However, a small proportion arise outside of the lung and are termed extrapulmonary (EP)-, poorly differentiated (PD)-NECs. Patients with local or locoregional disease may benefit from surgical excision; however, this is often not an option, due to late presentation. To date, treatment has mirrored that of small-cell lung cancer, with platinum–etoposide forming the basis of first-line treatment. There is a lack of consensus in relation to the most effective second-line treatment option. Low incidence, an absence of representative preclinical models and a lack of understanding of the tumour microenvironment all present challenges to drug development in this disease group. However, progress made in elucidating the mutational landscape of EP-PD-NEC and the observations made in several clinical trials are paving the way towards improving outcomes for these patients. The optimisation and strategic delivery of chemotherapeutic interventions according to tumour characteristics and the utilisation of targeted and immune therapies in clinical studies have yielded mixed results. Targeted therapies that complement specific genetic aberrations are under investigation, including AURKA inhibitors in those with MYCN amplifications, BRAF inhibitors in those with BRAFV600E mutations and EGFR suppression, and Ataxia Telangiectasia and Rad3-related inhibitors in patients with ATM mutations. Immune checkpoint inhibitors (ICIs) have conferred promising results in several clinical trials, particularly with dual ICIs and in combination with targeted therapy or chemotherapy. However, further prospective investigations are required to elucidate the impact of programmed cell death ligand 1 expression, tumour mutational burden and microsatellite instability on response. This review aims to explore the most recent developments in the treatment of EP-PD-NEC and contribute towards the requirement for clinical guidance founded on prospective evidence.

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Surgical resection of high‐grade nonfunctional pancreatic neuroendocrine carcinoma is associated with improved survival

Cited by 7 publications

References 18 publications

Multidisciplinary Approach for the Management of Metastatic Poorly Differentiated Neuroendocrine Carcinoma of the Pancreas

Multidisciplinary Approach for the Management of Metastatic Poorly Differentiated Neuroendocrine Carcinoma of the Pancreas

Survival Benefit of Surgical Resection for Pancreatic Neuroendocrine Tumors With Oligometastatic Liver Metastasis: A Retrospective and Propensity Score-Matching Analysis

Future therapeutic strategies in the treatment of extrapulmonary neuroendocrine carcinoma: a review

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