Resection of primary tumor site is associated with prolonged survival in metastatic nonfunctioning pancreatic neuroendocrine tumors

Abstract

Background Non-functioning pancreatic neuroendocrine tumors (NFpNET) present with distant metastases in up to 50% of patients. It is unknown whether removal of the primary tumor in patients with NFpNET and metastases is beneficial. Methods We used the Surveillance, Epidemiology and End Results (SEER) database to identify patients with NFpNET and distant metastases. The primary outcome measure in this study was overall survival. Results We identified 882 patients with metastatic NFpNET and survival data. 303 (34%) patients had surgical removal of their primary tumor of which 243 (80%) were grade I or II. Median survival of patients undergoing surgery was 65 (95% CI: 60–86) versus 10 (8–12) months for those without surgery (p<0.0001). Patients diagnosed after 2003 (n=625, 71%) were more likely to undergo an operation than those diagnosed earlier (p=0.001). Multivariable analysis showed that lower tumor grade (p<0.0001), younger age (p<0.0001), diagnosis during or after 2003 (p=0.0003), tumor site in the body/tail (p=0.009) and surgical resection of the primary tumor site (p<0.0001) were significantly associated with prolonged survival of patients with NFpNET and distant metastases. Conclusions This study suggests that surgical removal of primary NFpNET is associated with longer survival in patients with distant metastases and could therefore be considered as a additional treatment option in this patient population.

Localization of Unknown Primary Site with 68Ga-DOTATOC PET/CT in Patients with Metastatic Neuroendocrine Tumor

“…Localization of the primary tumor is highly relevant in the management of this patient population because complete resection of the primary tumor and metastases is the treatment goal for patients with well-differentiated NET metastases (2). Even if the metastases are not completely resectable, debulking surgery can improve symptom control in patients with endocrine symptoms and may improve survival (2)(3)(4).…”

Pancreatic Neuroendocrine Tumors: How Much Surgery is Safe?

“…Nevertheless survival is higher in specialized centers and may depend on the multidisciplinary approach [10]. Another group showed that the resection of the primary tumor improves patient outcome in non-functional pNET [22]. Despite advanced tumor stages we found relatively long disease free survivals of 21 months in group Ia and 8.7 months in group IIa.…”

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

“…Cytoreduction may be considered if removal of over 90% of the tumour mass is possible, even if hepatic metastases are present [164] (*evidence level 3). Removal of 90% of the visible tumour mass is possible in only 5-15% of cases [165].…”

“…Cytoreductive procedures are acceptable [167,168] (*evidence level 2). Resective treatment of hepatic metastases of PNETs is considered only in NETs of G1 and G2 [164] (*evidence level 3). It depends on the resectability of the lymph nodes, lack of micronodular or non-resectable dissemination in the peritoneum, or distant metastases outside the abdominal cavity [169].…”