Clinical Prognosticators of Metastatic Potential in Patients with Small Pancreatic Neuroendocrine Tumors

Vega, Eduardo; Kutlu, Onur; Alarcon, Sylvia V.; Salehi, Omid; Kazakova, Vera; Kozyreva, Olga; Chan, Jennifer A.; Conrad, Claudius

doi:10.1007/s11605-021-04946-x

Cited by 11 publications

(23 citation statements)

References 28 publications

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“…In our data, after the exclusion of patients with distant metastasis, the incidence of LNM was 9.9% in 751 patients with at least one examined lymph node. In line with most previous studies ( 9 , 13 , 14 , 23 ), LNM was associated with the poor prognosis of small NF-PNETs in our study, suggesting the necessity of surgical resection and regional lymphadenectomy for patients with a high risk of LNM. Factors including age ( 9 ), tumor size ( 13 ), Ki-67 index ( 23 ), and lymphovascular invasion ( 14 ) have been considered predictors of LNM.…”

Section: Discussionsupporting

confidence: 92%

“…Considering the relatively high risk of morbidity and mortality in pancreatic surgery as well as the indolent course of small NF-PNETs, both National Comprehensive Cancer Network (NCCN) and European Neuroendocrine Tumor Society (ENETS) guidelines suggest that patients with an asymptomatic small tumor may be selectively observed ( 2 , 8 ). Nevertheless, results from some surgical cohorts showed that 10%–15% of small NF-PNETs had the malignant potential with regional and distant metastases for which surgery is recommended ( 9 – 12 ). Moreover, although patients with small NF-PNETs generally have a good prognosis after surgery, 4%–6% of recurrences or tumor-related deaths have been observed ( 9 , 13 – 15 ).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, results from some surgical cohorts showed that 10%–15% of small NF-PNETs had the malignant potential with regional and distant metastases for which surgery is recommended ( 9 – 12 ). Moreover, although patients with small NF-PNETs generally have a good prognosis after surgery, 4%–6% of recurrences or tumor-related deaths have been observed ( 9 , 13 – 15 ). Due to the overall rarity and heterogeneity, the prognostic factors of small NF-PNETs are not well defined.…”

Section: Introductionmentioning

confidence: 99%

“…Vega et al. found that LNM was an independent predictor of poor disease-specific survival (DSS) and overall survival ( 9 ). Data from the National Cancer Database (NCDB) showed that LNM significantly decreased the disease-free survival (DFS) in patients with small NF-PNETs (mean survival: 115 vs. 95 months, p < 0.0001) ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Pancreatic neuroendocrine neoplasms (PNENs) are rare tumors of the pancreas and occur in less than 2% of all pancreatic tumors ( 1 ). However, the incidence of PNENs has been reported to have increased dramatically over the past few decades, resulting in 0.8/100,000 per year ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Pancreatic Neuroendocrine Tumor With Liver Metastasis and Portal Vein Thrombosis

et al. 2022

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IntroductionPancreatic neuroendocrine neoplasms (PNENs) are rare pancreatic tumors originating from pancreatic neuroendocrine cells. There is no consensus on the treatment for PNENs with unresectable liver metastases. Transcatheter arterial chemoembolization (TACE) is the preferred treatment for unresectable primary liver cancer. But the efficacy of TACE and anticoagulation in PNENs with unresectable liver metastases and portal vein thrombosis has never been reported.Methods and ResultsWe present the case of a 50-year-old male patient with hepatitis C who was found to have a single liver mass during a regular physical examination in 2016. The liver mass was surgically removed. Postoperative pathology suggested a neuroendocrine tumor of the liver, and it was suggested to look for the primary tumor. The patient was followed up until 2020, and the primary pancreatic tumor was found, along with multiple liver metastases and portal vein thrombosis. After transcatheter arterial embolization, anticoagulation, and endocrine therapy, the patient’s tumor load was relieved, and the portal vein was recanalized.ConclusionThe article reports the disease course in a case of a functional pancreatic neuroendocrine tumor with liver metastasis and portal vein thrombosis and reviews previous literature. To our knowledge, we reported for the first time the efficacy of TACE and anticoagulation in PNENs with unresectable liver metastases and portal vein thrombosis.

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The management of small nonfunctional pancreatic neuroendocrine tumors: It's time to define the high‐risk features

Tan

Chengzhi

Chen

2022

Journal of Surgical Oncology

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Clinical Prognosticators of Metastatic Potential in Patients with Small Pancreatic Neuroendocrine Tumors

Cited by 11 publications

References 28 publications

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

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

Case Report: Pancreatic Neuroendocrine Tumor With Liver Metastasis and Portal Vein Thrombosis

The management of small nonfunctional pancreatic neuroendocrine tumors: It's time to define the high‐risk features

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