Outcomes after primary tumor resection of metastatic pancreatic neuroendocrine tumors: An analysis of the National Cancer Database

Abstract

Introduction: There is no consensus regarding the role of primary tumor resection for patients with metastatic pancreatic neuroendocrine tumors (panNET). We assessed surgical treatment patterns and evaluated the survival impact of primary tumor resection in patients with metastatic panNET.Methods: Patients with synchronous metastatic nonfunctional panNET in the National Cancer Database (2004Database ( −2016 were categorized based on whether they underwent primary tumor resection. We used logistic regressions to assess associations with primary tumor resection. We performed survival analyses with Kaplan−Meier survival functions, log-rank test, and Cox proportional hazard regression within a propensity score matched cohort.Results: In the overall cohort of 2613 patients, 68% (n = 839) underwent primary tumor resection. The proportion of patients who underwent primary tumor resection decreased over time from 36% (2004) to 16% (2016, p < 0.001).After propensity score matching on age at diagnosis, median income quartile, tumor grade, size, liver metastasis, and hospital type, primary tumor resection was associated with longer median overall survival (OS) (65 vs. 24 months; p < 0.001) and was associated with lower hazard of mortality (HR: 0.39, p < 0.001). Conclusion:Primary tumor resection was significantly associated with improved OS, suggesting that, if feasible, surgical resection can be considered for well-selected patients with panNET and synchronous metastasis. | INTRODUCTIONPancreatic neuroendocrine tumors (panNETs) are a rare, but increasingly prevalent, set of neoplasms that may be associated with functional hormonal syndromes, multiple endocrine neoplasia type I, and von-Hippel−Lindau syndrome, among others. 1,2 Among pan-NETs, nonfunctional tumors are not only more prevalent but also diagnosed at more advanced stage, with more than half of patients presenting with metastasis at diagnosis. 3 Patients with distant metastases at diagnosis experience significantly shorter overall

Predicting Liver Metastasis in Pancreatic Neuroendocrine Tumor After Surgery: A Population-Based Study

“…Liver metastasis is the major metastatic site of pNET which causes a poor prognosis and a huge economic and social burden for these patients due to the application of various therapies not just through surgery (5,10). Although comprehensive treatment such as reoperation of metastatic lesions (11,12), focal therapy (transarterial chemoembolization, radiofrequency and microwave ablation) (13,14) and systemic therapy (sunitinib and everolimus) (15,16) or even liver transplantation (17) have been widely accepted to achieve an outstanding bene t of survival for pNET patients with liver metastasis, early detection of liver micrometastasis after primary site resection is still hard via imagological examination, such as CT scan or liver MRI. Moreover, inappropriate follow-up strategy after surgery due to no discrimination to all patients can also lead to a delayed intervention (18).…”