Prognostic factors of long-term outcome in surgically resectable pancreatic neuroendocrine tumors: A 12-year experience from a single center

Abstract

The present study was performed to assess the prognostic factors with respect to patient survival and clinicopathological characteristics for patients who underwent surgery for pancreatic neuroendocrine tumors (PNETs). A retrospective review of patients pathologically diagnosed with PNETs at the First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou, Zhejiang, China) between September 2002 and September 2013 was conducted. The clinicopathological findings, overall survival (OS) rate and disease-free survival (DFS) rate of the patients with PNETs were analyzed. Prognostic factors were determined by univariate and multivariate analyses. A total of 104 patients were selected. The median age at presentation was 52 years (range, 19–76 years). The most common surgical procedure was distal pancreatectomy (51.0%), followed by pancreaticoduodenectomy (27.9%) and local resection of the pancreas (16.3%). The majority of the tumors were of low or moderate grade (93.3%, grade 1 or 2) and were local or regional stage (92.3%). The 1-, 3- and 5-year OS rates were 95, 85 and 73%, respectively. Meanwhile, the 1-, 3- and 5-year DFS rates were 86, 72 and 68%, respectively. The OS and DFS rates were significantly different with regard to the grade (grades 1, 2 and 3; P<0.001) and stage (local, regional and distant disease; P<0.001). Furthermore, patients with a low Ki-67 index experienced superior OS and DFS rates compared with patients with a high Ki-67 index (P<0.001). The presence of lymph node metastasis was predictive of inferior OS and DFS rates compared with the absence of lymph node metastasis (P<0.001). OS rate for PNETs was significantly affected by resection margin status (P<0.001). In multivariable analysis, the significant factors associated with OS rate were stage (P=0.02), grade (P<0.001), lymph node status (P=0.025), Ki-67 index (P=0.031) and resection margin status (P<0.001). Meanwhile, stage (P=0.001), grade (P=0.017), lymph node status (P=0.02) and Ki-67 index (P=0.016) were prognostic factors for DFS rate. In conclusion, grade, stage, Ki-67 index and lymph node involvement are significant prognostic factors for OS and DFS rates in surgically resectable PNETs. Furthermore, surgical margin status may also be an independent predictor for the prognosis of PNETs. It is anticipated that these findings may provide useful predictors of clinical survival, particularly in the setting of resected disease.

Outcomes after Surgery for Malignant Pancreatic Neuroendocrine Tumors

“…Tumor factors that exhibit no any effect on the disease recurrence were found to be tumor size, location, angio-invasion and gross invasion to other viscera as type of operation that is performed and postoperative chemotherapy. This study revealed significant association between the disease recurrence with tumor grade (Pvalue 0.027), lymph node involvement (P-value 0.027) and tumor stage (P-value 0.017), which is near to the results achieved by other authors [32,33]. Among patient's variables that impact on survival jaundice alone as a presenting symptom left significant effect on survival with a (P-value 0.018) with the rest of the patients factors have no significant role on survival.…”

A meta-analysis of Prognostic factor of Pancreatic neuroendocrine neoplasms

“…Present organ metastasis might indicate low overall survival of pNENs according to the data provided by 3 of 4 articles 13 , 20 , 27 and the combined data (Table 4 , Fig. 3D ).…”

“…2 of 6 studies 13 , 21 suggested that poor prognosis of pNENs was associated with advanced G stage, while 4 of 6 studies 12 , 20 , 26 , 27 had no statistical difference between people with high or low G stage. Our pooled data showed that patients with advanced G stage were prone to suffer from pNENs (Table 4 , Fig.…”

“…While 2 of 6 articles 19 , 23 showed no difference in people with or without lymph node invasion, 4 articles 17 , 20 – 22 reflected that people with lymph node invasion had worse prognosis than people without lymph node invasion. The combined data subordinate to the majority (Table 4 , Fig.…”

High vimentin expression with E-cadherin expression loss predicts a poor prognosis after resection of grade 1 and 2 pancreatic neuroendocrine tumors

“…Compared with pancreatic ductal adenocarcinoma, pNETs have better long-term survival rates [ 5 , 6 ]. Recently, several large cohort studies found that lymph node involvement, tumor stage and grade, tumor size and Ki-67 index scores could predict the prognosis of pNETs [ 5 – 7 ]. However, some patients with small tumors or tumors with a low World Health Organization (WHO) grade (grade 1 or 2) may exhibit liver or lymph node metastasis and have a poor prognosis [ 8 ].…”