Yassar M Hashim1, Kathryn M Trinkaus, David C Linehan, Steven S Strasberg, Ryan C Fields, Dengfeng Cao, William G Hawkins. 1. *Department of Surgery and the Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO †Division of Biostatistics, Washington University School of Medicine, St. Louis, MO; and ‡Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, and Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing, China.
Abstract
OBJECTIVE: To explore the prognostic importance and preoperative predictors of lymph node metastasis in an effort to guide surgical decision making in patients with pancreatic neuroendocrine tumors (PNETs). BACKGROUND: PNETs are uncommon, and the natural history of the disease is not well described. As a result, there remains controversy regarding the optimal management of regional lymph nodes during resection of the primary tumor. METHODS: A retrospective review of a prospectively maintained database of patients who underwent surgery for locoregional PNET between 1994 and 2012 was performed. Logistic regression was used to identify predictors of nodal metastasis. Overall survival and disease-free survival were calculated using Kaplan-Meier method. Results were expressed as P values and odds ratio estimates, with 95% confidence intervals. RESULTS: One hundred thirty-six patients were identified, of whom 50 (38%) patients had nodal metastasis. The frequency of lymph node metastasis was higher for larger tumors [> 1.5 cm (odds ratio [OR] = 4.7)], tumors of the head as compared with body-tail of the pancreas (OR = 2.8), tumors with Ki-67 greater than 20% (OR = 6.7), and tumors with lymph vascular invasion (OR = 3.6) (P < 0.05). Median disease-free survival was lower for patients with nodal metastases (4.5 vs 14.6 years, P < 0.0001). CONCLUSIONS: Lymph node metastasis is predictive of poor outcomes in patients with PNETs. Preoperative variables are not able to reliably predict patients where the probability of lymph node involvement was less than 12%. These data support inclusion of regional lymphadenectomy in patients undergoing pancreatic resections for PNET.
OBJECTIVE: To explore the prognostic importance and preoperative predictors of lymph node metastasis in an effort to guide surgical decision making in patients with pancreatic neuroendocrine tumors (PNETs). BACKGROUND: PNETs are uncommon, and the natural history of the disease is not well described. As a result, there remains controversy regarding the optimal management of regional lymph nodes during resection of the primary tumor. METHODS: A retrospective review of a prospectively maintained database of patients who underwent surgery for locoregional PNET between 1994 and 2012 was performed. Logistic regression was used to identify predictors of nodal metastasis. Overall survival and disease-free survival were calculated using Kaplan-Meier method. Results were expressed as P values and odds ratio estimates, with 95% confidence intervals. RESULTS: One hundred thirty-six patients were identified, of whom 50 (38%) patients had nodal metastasis. The frequency of lymph node metastasis was higher for larger tumors [> 1.5 cm (odds ratio [OR] = 4.7)], tumors of the head as compared with body-tail of the pancreas (OR = 2.8), tumors with Ki-67 greater than 20% (OR = 6.7), and tumors with lymph vascular invasion (OR = 3.6) (P < 0.05). Median disease-free survival was lower for patients with nodal metastases (4.5 vs 14.6 years, P < 0.0001). CONCLUSIONS: Lymph node metastasis is predictive of poor outcomes in patients with PNETs. Preoperative variables are not able to reliably predict patients where the probability of lymph node involvement was less than 12%. These data support inclusion of regional lymphadenectomy in patients undergoing pancreatic resections for PNET.
Authors: Nicholas A Hamilton; Matthew R Porembka; Fabian M Johnston; Feng Gao; Steven M Strasberg; David C Linehan; William G Hawkins Journal: Ann Surg Date: 2012-06 Impact factor: 12.969
Authors: Alex B Haynes; Vikram Deshpande; Thun Ingkakul; Parsia A Vagefi; Jackie Szymonifka; Sarah P Thayer; Cristina R Ferrone; Jennifer A Wargo; Andrew L Warshaw; Carlos Fernández-del Castillo Journal: Arch Surg Date: 2011-05
Authors: P Tomassetti; D Campana; L Piscitelli; R Casadei; D Santini; F Nori; A M Morselli-Labate; R Pezzilli; R Corinaldesi Journal: Ann Oncol Date: 2005-08-05 Impact factor: 32.976
Authors: Megan Dann Fesinmeyer; Melissa A Austin; Christopher I Li; Anneclaire J De Roos; Deborah J Bowen Journal: Cancer Epidemiol Biomarkers Prev Date: 2005-07 Impact factor: 4.254
Authors: James C Yao; Manal Hassan; Alexandria Phan; Cecile Dagohoy; Colleen Leary; Jeannette E Mares; Eddie K Abdalla; Jason B Fleming; Jean-Nicolas Vauthey; Asif Rashid; Douglas B Evans Journal: J Clin Oncol Date: 2008-06-20 Impact factor: 44.544
Authors: R Bettini; L Boninsegna; W Mantovani; P Capelli; C Bassi; P Pederzoli; G F Delle Fave; F Panzuto; A Scarpa; M Falconi Journal: Ann Oncol Date: 2008-01-21 Impact factor: 32.976
Authors: Karl Y Bilimoria; Mark S Talamonti; James S Tomlinson; Andrew K Stewart; David P Winchester; Clifford Y Ko; David J Bentrem Journal: Ann Surg Date: 2008-03 Impact factor: 12.969
Authors: James R Howe; Nipun B Merchant; Claudius Conrad; Xavier M Keutgen; Julie Hallet; Jeffrey A Drebin; Rebecca M Minter; Terry C Lairmore; Jennifer F Tseng; Herbert J Zeh; Steven K Libutti; Gagandeep Singh; Jeffrey E Lee; Thomas A Hope; Michelle K Kim; Yusuf Menda; Thorvardur R Halfdanarson; Jennifer A Chan; Rodney F Pommier Journal: Pancreas Date: 2020-01 Impact factor: 3.327
Authors: Ding Ding; Ammar A Javed; Chunhui Yuan; Michael J Wright; Zunaira N Javed; Jonathan A Teinor; I Chae Ye; Richard A Burkhart; John L Cameron; Matthew J Weiss; Christopher L Wolfgang; Jin He Journal: J Gastrointest Surg Date: 2020-02-05 Impact factor: 3.452
Authors: Thomas Curran; Barbara A Pockaj; Richard J Gray; Thorvardur R Halfdanarson; Nabil Wasif Journal: J Gastrointest Surg Date: 2014-08-14 Impact factor: 3.452
Authors: M Falconi; B Eriksson; G Kaltsas; D K Bartsch; J Capdevila; M Caplin; B Kos-Kudla; D Kwekkeboom; G Rindi; G Klöppel; N Reed; R Kianmanesh; R T Jensen Journal: Neuroendocrinology Date: 2016-01-05 Impact factor: 4.914