Predictive factors associated with long-term survival in patients with neuroendocrine tumors of the pancreas

Chu, Quyen D.; Hill, Hank C.; Douglass, Harold O.; Driscoll, Deborah L.; Smith, Judy L.; Nava, Hector; Gibbs, John F.

doi:10.1007/bf02557521

Cited by 142 publications

(83 citation statements)

References 12 publications

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“…The median length of our follow-up, i.e. 42.5 months, is in agreement with the follow-up value reported in other studies (Burke et al 1997, Madeira et al 1998, Chu et al 2002, Hochwald et al 2002, Furlan et al 2004). This value is influenced by several elements, such as the inclusion of patients with recent diagnosis of GEP ET and the finding that most deaths occur at a short interval of time from diagnosis (median 18 months).…”

Section: Discussionsupporting

confidence: 92%

“…The survival rate observed in our series, for PETs, is in agreement with other studies (Rigaud et al 2001, Gullo et al 2003, in which a survival of 50-70% was reported. However, it is higher than the data reported by Modlin et al (2003) in a retrospective analysis of a cancer registry referring to the last three decades; and also data reported by Kent et al (1981), Chu et al (2002) and Lepage et al (2004) who reported a survival rate of 30-40%. This discrepancy is probably due not only to the different features of the populations studied, which included mostly patients with advanced disease, but also to the different design of the studies, generally retrospective (Modlin et al 2003, Lepage et al 2004, Chu et al 2002, Gullo et al 2003.…”

Section: Discussionmentioning

confidence: 56%

“…However, it is higher than the data reported by Modlin et al (2003) in a retrospective analysis of a cancer registry referring to the last three decades; and also data reported by Kent et al (1981), Chu et al (2002) and Lepage et al (2004) who reported a survival rate of 30-40%. This discrepancy is probably due not only to the different features of the populations studied, which included mostly patients with advanced disease, but also to the different design of the studies, generally retrospective (Modlin et al 2003, Lepage et al 2004, Chu et al 2002, Gullo et al 2003. In the present study, the negative impact of the pancreatic primary tumor localization may also be related to the association with other negative prognostic factors, such as poor tumor cell differentiation, high Ki67 value and larger tumor size (Tables 2 and 4).…”

Section: Discussionmentioning

confidence: 56%

“…Furthermore, despite the increasing interest in GEP ETs over the last few years, few studies have been addressed at evaluating series of patients including both 'functioning' and 'non-functioning' tumors that originated either in the GI tract or in the pancreas. Although some reports have prospectively investigated the clinical course and the survival of patients with gastrinoma (Yu et al 1999, Weber et al 1995, the majority of the studies including other kinds of GEP ETs refer to retrospective studies (Burke et al 1997, Madeira et al 1998, Phan et al 1998, Shebani et al 1999, Quaedvlieg et al 2001, Chu et al 2002, Hochwald et al 2002, Gullo et al 2003, Modlin et al 2003, Pape et al 2004, some of them evaluating data reported from national cancer registries (Shebani et al 1999, Quaedvlieg et al 2001, Modlin et al 2003. Moreover, the majority of the published studies have enrolled only patients with either PETs (Phan et al 1998, Hochwald et al 2002, Gullo et al 2003, Gibril & Jensen 2004 or GI carcinoids (Burke et al 1997, Shebani et al 1999, Soreide et al 2000, both kinds of tumors have been rarely investigated in the same study (Madeira et al 1998, Johanson et al 1999, Pape et al 2004.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization

Panzuto¹,

Nasoni²,

Falconi³

et al. 2005

Endocr Relat Cancer

359

276

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Since gastro-entero-pancreatic endocrine tumors are rare and heterogeneous diseases, their prognosis and long-term survival are not well known. This study aimed at identifying prognostic factors and assessing long-term survival in gastro-entero-pancreatic endocrine tumors. A total of 156 patients enrolled. Prognostic factors were determined by univariate/multivariate analysis; survival rates were assessed by the Kaplan-Meier method. The tumors were non-functioning in 59.6% of patients, and originated from the pancreas in 42.9%. At diagnosis, 64.3% of patients had metastases. The tumors were well differentiated in 89.6% of patients. Ki67 was >2% in 39.6% of patients. Primary tumor size was >3 cm in 49.6% of cases studied. For the univariate analysis, the negative prognostic factors were: pancreatic origin (rate ratio 4.64, P = 0.0002), poorly differentiated tumor (rate ratio 7.70, P = 0.0001), primary tumor size >3 cm (rate ratio 4.26, P = 0.0009), presence of distant metastases (liver: rate ratio 5.88, P = 0.01; distant extra-hepatic: rate ratio 13.41, P = 0.0008). The pancreatic site, the poor degree of differentiation and the distant metastases were confirmed as negative prognostic factors at multivariate analysis. Overall 5-year survival rate was 77.5%. Survival rates differed according to: primary tumor site (62% for pancreatic vs 89.9% for gastrointestinal tract, P = 0.0001) and size (65.7% for >3 cm vs 88.8% for £ 3 cm, P = 0.0003), degree of differentiation (22% for poor vs 86.8% for good, P<0.0001), Ki67 (53.5% for >2% vs 90.1% for £ 2%, P = 0.003), metastases (96.1, 77, 73.3 and 50.1% for absent, local, liver and distant extra-hepatic metastases respectively), age at diagnosis (85.3% for £ 50 years vs 70.3% for >50 years, P = 0.03). Although 64.3% of gastro-entero-pancreatic endocrine tumors present metastases at diagnosis, the 5-year survival rate is 77.5%. Pancreatic site, a poor degree of tumor cell differentiation and distant extra-hepatic metastases are the major negative prognostic factors.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization

Panzuto¹,

Nasoni²,

Falconi³

et al. 2005

Endocr Relat Cancer

359

276

View full text Add to dashboard Cite

show abstract

“…These data suggest that in patients diagnosed with pancreatic NETs CgA evaluation might be useful to identify patients in which local and distant metastases should be looked for by an accurate clinical evaluation. This issue is important, since it has been previously demonstrated that in pancreatic NETs, the presence of metastases profoundly influences survival rate, which is significantly better in patients without metastases (Madeira et al 1998, Chu et al 2002, Gullo et al 2003, Panzuto et al 2005. Moreover, the 5-year survival rate was reported to be 60-100% for localized disease, 40% for regional disease, 29% for distant metastases, and 80% for all stages (Eriksson et al 1990, Modlin et al 2003.…”

Section: Discussionmentioning

confidence: 98%

Chromogranin A as a marker of neuroendocrine neoplasia: an Italian Multicenter Study

Zatelli¹,

Torta²,

Leon³

et al. 2007

Endocr Relat Cancer

134

103

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Elevated circulating chromogranin A (CgA) levels are found in neuroendocrine tumors (NETs), but the diagnostic usefulness of this marker is still debatable. To assess the role of CgA for the diagnosis of gastroenteropancreatic (GEP) NETs and the identification of metastatic patients, an Italian multicenter observational study has been performed. CgA was evaluated in 202 GEP NET patients by IRMA and ELISA. The cutoffs for diagnosis and presence of metastases were identified by receiver-operating characteristic (ROC) curve. We found good correlation between IRMA and ELISA. The ROC analysis identified a cutoff of 53 ng/ml for IRMA and 16 U/l for ELISA as discriminating between controls and patients with active disease (sensitivity 71.3 and 84%; specificity 71 and 85% respectively). Metastases were present in 123 patients, having significantly higher CgA levels than patients without metastases. ROC analysis identified a cutoff of 146 ng/ml for IRMA and 67.3 U/l for ELISA as discriminating between patients with and without metastases (sensitivity 57 and 63.3%; specificity 55.6 and 71.4% respectively). For pancreatic NETs positive and negative predictive values were 84 and 78% respectively (90% specificity and 68% sensitivity). We found lower CgA levels in patients with extensive metastatic spread than in those with liver metastases only. These data assess the role of CgA evaluation in GEP NETs, and demonstrate that higher CgA levels associate with metastatic disease, confirming that CgA levels can provide a helpful practical biochemical marker for the clinical management of NETs, but with low sensitivity and specificity.

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Resection of Pancreatic Neuroendocrine Tumors

Kazanjian

Reber²,

Hines³

2006

Arch Surg

137

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Results: Of the 70 patients, 50 (71.4%) had nonfunctional tumors. Thirty-seven patients (52.9%) had neuroendocrine carcinomas and 13 (18.6%) had benign islet cell neoplasms. Twenty patients had functional tumors. Of these 20 patients, 16 had insulinomas, 2 had glucagonomas, and 2 had gastrinomas. Twenty-seven patients underwent pancreaticoduodenectomy, 32 had distal pancreatectomy, and 11 underwent enucleation. Patients undergoing enucleation as compared with those not undergoing enucleation were younger (mean age, 39 vs 51 years, respectively; P=.009) and had smaller tumors (mean tumor size, 2 vs 5 cm, respectively; PϽ.001). Postoperative complications occurred in 13 patients (48.1%) after pancreaticoduodenectomy, in 4 patients (12.5%) after distal pancreatectomy, and in 0 patients after enucleation. There were no perioperative mortalities. With a median follow-up of 50 months, the 5-year actuarial survival for the patients with malignant neuroendocrine carcinomas (n=37) was 77%, and all of the patients with functional tumors are alive. The presence of lymphovascular invasion closely approached significance when survival was evaluated (P=.06). Lymph node status, perineural invasion, and liver metastasis did not impact survival. Conclusions: This single-institutional case series demonstrates that pancreatic neuroendocrine tumors can be safely resected without mortality and with minimal morbidity. The presence of lymphovascular invasion can be used to classify neuroendocrine tumors as malignant, and this appears to predict survival. Patients with malignant tumors can expect long-term survival even in the setting of metastatic disease.

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Predictive factors associated with long-term survival in patients with neuroendocrine tumors of the pancreas

Abstract: Definitive surgical resection of the primary tumor, absence of liver metastases, metachronous liver metastases, and aggressive treatment of the liver metastases were predictors of long-term survival in patients with neuroendocrine tumors of the pancreas.

Cited by 142 publications

References 12 publications

Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization

Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization

Chromogranin A as a marker of neuroendocrine neoplasia: an Italian Multicenter Study

Resection of Pancreatic Neuroendocrine Tumors

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