Prognostic Value of Lymph Node Status and Extent of Lymphadenectomy in Pancreatic Neuroendocrine Tumors Confined To and Extending Beyond the Pancreas

Conrad, Claudius; Kutlu, Onur; Dasari, Arvind; Chan, Jennifer A.; Vauthey, Jean Nicolas; Adams, David B.; Kim, Michael; Fleming, Jason B.; Katz, Matthew H.; Lee, Jeffrey E.

doi:10.1007/s11605-016-3243-7

Cited by 56 publications

(26 citation statements)

References 23 publications

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“…Surprisingly, we found the extent of ELNs failed to demonstrate any survival benefit in entire cohort (ELNs > 12 vs. ELNs ≤ 12) or in the negative lymph node metastasis pNENs (ELNs > 28 vs. ELNs ≤ 28). Similar to our findings, Conrad et al [ 28 ] also demonstrated that the extent of ELNs (ELNs ≥ 10) failed to show significant survival advantage.…”

Section: Discussionsupporting

confidence: 92%

Lymph node ratio, but not the total number of examined lymph nodes or lymph node metastasis, is a predictor of overall survival for pancreatic neuroendocrine neoplasms after surgical resection

et al. 2017

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AimTo evaluate the prognostic significance of lymph node metastasis, extent of examined lymph nodes (ELNs) and lymph node ratio (LNR) for resected pancreatic neuroendocrine neoplasms (pNENs).Materials and MethodsSurgically resected pNENs were assimilated from the Surveillance, Epidemiology, and End Results database. Kaplan-Meier and Cox proportional hazard models were used to examine the prognostic effect of clinicopathological characteristics on overall survival; Harrell’s concordance index was performed to assess the prognostic accuracy of all independent prognostic factors; and the Spearman’s rank correlation was used to assess the correlation between LNR and other clinicopathological characteristics.ResultsTotally, 1,273 pathologically confirmed pNENs were included in our study. The extent of ELNs failed to show any survival benefit in entire cohort (ELNs ≤ 12 vs. ELNs > 12, P = 0.072) or pNENs without lymph node metastasis (ELNs ≤ 28 vs. ELNs > 28, P = 0.108). Lymph node metastasis and LNR > 0.40 were significantly (both P < 0.001) adverse prognostic factors of overall survival. However, only LNR > 0.40 was the independent predictor of survival after adjusted for other clinicopathological characteristics. Besides LNR, the age, gender, primary tumor site, grade and stage also were the independent predictors of overall survival; and this survival model had an acceptable predictive power (Harrell’s concordance index, 0.731).ConclusionsThe current study suggested that the LNR, not the total number of ELNs and the lymph node metastasis, is an independent prognostic indicator of overall survival for pNENs after surgical resection.

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Section: Discussionsupporting

confidence: 92%

Lymph node ratio, but not the total number of examined lymph nodes or lymph node metastasis, is a predictor of overall survival for pancreatic neuroendocrine neoplasms after surgical resection

et al. 2017

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“…In the current study, we showed that 26.7% (27/101) NF-PNETs patients had LN metastases when diagnosed. Furthermore, LN metastases was associated with decreased DFS, which was similar to previous studies 9 , 10 . Interestingly, our study also showed that preoperative NLR ≥ 1.80, tumor size ≥ 2.5 cm and symptomatic diagnosis were independently associated with LN metastases for patients undergoing resection of NF-PNETs.…”

Section: Discussionsupporting

confidence: 90%

“…The current American Joint Committee on Cancer Staging (AJCC) and European Neuroendocrine Tumor Society (ENETS) considers tumor size, lymph node (LN) metastasis, and presence of distant metastasis in its staging criteria 6 – 8 . In addition, more and more evidence demonstrated that LN metastasis was an independent prognostic factor for PNETs 9 , 10 . Therefore, the investigation of factors related to LN metastases has a great clinical significance.…”

Section: Introductionmentioning

confidence: 99%

Preoperative neutrophil-to-lymphocyte ratio and tumor-related factors to predict lymph node metastasis in nonfunctioning pancreatic neuroendocrine tumors

Zhou

Deng

Chen

et al. 2017

Sci Rep

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The lymph node (LN) status is very important for the survival in pancreatic neuroendocrine tumors (PNETs). Therefore, the investigation of factors related to LN metastases has a great clinical significance. The aim of this study was to evaluate the predictive value of the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and possible clinical parameters on the LN metastases in nonfunctional PNETs (NF-PNETs). A retrospective review of 101 NF-PNET patients following curative resection and lymphadenectomy was conducted. The associations between clinicopathological factors and LN metastases and prognosis were determined. Twenty-seven (26.7%) patients had LN metastases. LN metastases was independently associated with disease-free survival (P = 0.009). Ideal cutoff values for predicting LN metastases were 1.80 for NLR, 168.25 for PLR and 2.5 cm for tumor size according to the receiver operating characteristic curve. On multivariable analysis, NLR (P = 0.017), symptomatic diagnosis (P = 0.028) and tumor size (P = 0.020) were associated with LN metastases. These results indicate that preoperative NLR ≥ 1.80, tumor size ≥2.5 cm and symptomatic diagnosis are independently associated with LN metastases for patients undergoing resection of NF-PNETs. It is anticipated that these findings are useful for further planning of lymphadenectomy before surgery.

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“…Lymph node involvement is one of the most powerful prognostic factors after surgical resection for PanNETs [53][54][55][56][57][58] . The optimal number of lymph nodes to be resected during pancreatic resection due to PanNETs is unknown [57] .…”

Section: Which Is the Role Of Lymphadenectomy During Pancreatic Resecmentioning

confidence: 99%

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

Partelli

Bartsch²,

Capdevila³

et al. 2017

Neuroendocrinology

255

260

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The small intestine and pancreas are among the most frequent abdominal sites of origin of neuroendocrine tumours. Distinctive features of these forms are represented by the relatively low incidence and the wide heterogeneity in biological behaviour. In this light, it is difficult to standardize indications for surgery and the most appropriate approach. It would be helpful for surgeons managing patients with these tumours to have guidelines for surgical treatment of small intestinal neuroendocrine tumours and pancreatic neuroendocrine tumours. The proposed guidelines represent a consensus of the working group of the European Neuroendocrine Tumor Society (ENETS).

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Prognostic Value of Lymph Node Status and Extent of Lymphadenectomy in Pancreatic Neuroendocrine Tumors Confined To and Extending Beyond the Pancreas

Abstract: While in T1-T2 pNET N1 status is a predictor of negative OS, similar outcome between NX and N0 supports limited LN resection in selected patients. Extended LA is unlikely to be helpful in T3-T4.

Cited by 56 publications

References 23 publications

Lymph node ratio, but not the total number of examined lymph nodes or lymph node metastasis, is a predictor of overall survival for pancreatic neuroendocrine neoplasms after surgical resection

Lymph node ratio, but not the total number of examined lymph nodes or lymph node metastasis, is a predictor of overall survival for pancreatic neuroendocrine neoplasms after surgical resection

Preoperative neutrophil-to-lymphocyte ratio and tumor-related factors to predict lymph node metastasis in nonfunctioning pancreatic neuroendocrine tumors

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

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