Current treatment status in pancreatic neuroendocrine neoplasms

Abstract

Pancreatic neuroendocrine neoplasms (P-NENs) are a group of pathologically and clinically heterogeneous tumors. In the past several decades, the incidence has been increasing. In 2010, the WHO presented a new classification dividing P-NENs into well-differentiated neuroendocrine tumors (NETs) and poorly-differentiated neuroendocrine carcinomas (NECs). Surgery is the primary and most important treatment for P-NENs, and is also the only possible curative procedure. By the 2018 NCCN guideline, observation can be considered for <1 cm, low-grade asymptomatic nonfunctional P-NETs. And for patients who are not suitable for surgery, somatostatin analogues, targeted therapy, radionuclides, ablation therapies, (chemo)embolisation and chemotherapy should be considered to improve and maintain a good quality of life. More than one hundred years has passed since termed, and in recent years, more and more molecule mechanism about P-NENs have been discovered. With the addition of several new agents, survival improved over the time. All this made P-NENs great promise.

Adrenocorticotropic Hormone-Producing Pancreatic Neuroendocrine Neoplasms: A Systematic Review

“…23 As a rare subtype of functional pNENs, the management of ACTHoma depends on symptoms, stage of disease, and histologic features. 37 The treatment of ACTHoma has 2 significant goals: (1) to alleviate the clinical symptoms and control hormone oversecretion and (2) to prolong the survival period by controlling tumor growth and/or decreasing tumor burden. 31,38 As surgical resection is the only possible curative procedure and can alleviate clinical symptoms secondary to ectopic ACTH hypersecretion, it is strongly recommended to remove the primary tumor and limited metastatic lesions.…”

“…To prolong the survival period, chemotherapy, radiation therapy, molecular targeted therapy, embolization, and radiofrequency ablation should be considered to control the tumor growth. 37,39,42 ACTHoma is extremely rare. Case reports or small case series accounted for a large proportion of the published literature.…”

Deaths of colon neuroendocrine tumors are associated with increasing metastatic lymph nodes and lymph node ratio

“…There is consensus on the retrieval of at least 12 lymph nodes in colon adenocarcinoma. LNR, a single parameter combining both the number of lymph nodes evaluated and the positive nodes, is superior to the AJCC classification, specifically for those patients with inadequate LN resected C D (7,15,16). In our study, we did not ascertain the number of LNs removed as a significant variable affecting survival.…”

“…LNR, as a reproducible and reliable prognostic indicator, was first described in gastric cancer studies (7,(14)(15)(16)(17). Recent evidence also implicated the LNR as a prominent prognostic factor, and it should be taken into consideration in the future for stratification schemes.…”

“…Obviously, prognostic heterogeneity should not be neglected among individual patients (e.g., N1 stage); yet, further precise stratification of patients in this group is warranted. Recent studies on many other NETs and solid tumors, including gastrointestinal and breast cancers, have unequivocally validated the importance of the number of positive lymph nodes (LNs) and the ratio between positive nodes and removed nodes (LNR) in determining patient outcomes (4)(5)(6)(7)(8). However, it remains unclear whether these two factors provide additional prognostic information for patients with C-NETs owing to the low intrinsic incidence of this disease.…”