Katiuscha Merath1, Fabio Bagante1,2, Eliza W Beal1, Alexandra G Lopez-Aguiar3, George Poultsides4, Eleftherios Makris4, Flavio Rocha5, Zaheer Kanji5, Sharon Weber6, Alexander Fisher6, Ryan Fields7, Bradley A Krasnick7, Kamran Idrees8, Paula M Smith8, Cliff Cho9, Megan Beems9, Carl R Schmidt1, Mary Dillhoff1, Shishir K Maithel3, Timothy M Pawlik1. 1. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio. 2. Department of Surgery, University of Verona, Verona, Italy. 3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia. 4. Department of Surgery, Stanford University, Palo Alto, California. 5. Department of Surgery, Virginia Mason Medical Center, Seattle, Washington. 6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 7. Department of Surgery, Washington University School of Medicine, St. Louis, Wisconsin. 8. Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, Tennessee. 9. Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Wisconsin.
Abstract
BACKGROUND: The risk of recurrence after resection of non-metastatic gastro-entero-pancreatic neuroendocrine tumors (GEP-NET) is poorly defined. We developed/validated a nomogram to predict risk of recurrence after curative-intent resection. METHODS: A training set to develop the nomogram and test set for validation were identified. The predictive ability of the nomogram was assessed using c-indices. RESULTS: Among 1477 patients, 673 (46%) were included in the training set and 804 (54%) in y the test set. On multivariable analysis, Ki-67, tumor size, nodal status, and invasion of adjacent organs were independent predictors of DFS. The risk of death increased by 8% for each percentage increase in the Ki-67 index (HR 1.08, 95% CI, 1.05-1.10; P < 0.001). GEP-NET invading adjacent organs had a HR of 1.65 (95% CI, 1.03-2.65; P = 0.038), similar to tumors ≥3 cm (HR 1.67, 95% CI, 1.11-2.51; P = 0.014). Patients with 1-3 positive nodes and patients with >3 positive nodes had a HR of 1.81 (95% CI, 1.12-2.87; P = 0.014) and 2.51 (95% CI, 1.50-4.24; P < 0.001), respectively. The nomogram demonstrated good ability to predict risk of recurrence (c-index: training set, 0.739; test set, 0.718). CONCLUSION: The nomogram was able to predict the risk of recurrence and can be easily applied in the clinical setting.
BACKGROUND: The risk of recurrence after resection of non-metastatic gastro-entero-pancreatic neuroendocrine tumors (GEP-NET) is poorly defined. We developed/validated a nomogram to predict risk of recurrence after curative-intent resection. METHODS: A training set to develop the nomogram and test set for validation were identified. The predictive ability of the nomogram was assessed using c-indices. RESULTS: Among 1477 patients, 673 (46%) were included in the training set and 804 (54%) in y the test set. On multivariable analysis, Ki-67, tumor size, nodal status, and invasion of adjacent organs were independent predictors of DFS. The risk of death increased by 8% for each percentage increase in the Ki-67 index (HR 1.08, 95% CI, 1.05-1.10; P < 0.001). GEP-NET invading adjacent organs had a HR of 1.65 (95% CI, 1.03-2.65; P = 0.038), similar to tumors ≥3 cm (HR 1.67, 95% CI, 1.11-2.51; P = 0.014). Patients with 1-3 positive nodes and patients with >3 positive nodes had a HR of 1.81 (95% CI, 1.12-2.87; P = 0.014) and 2.51 (95% CI, 1.50-4.24; P < 0.001), respectively. The nomogram demonstrated good ability to predict risk of recurrence (c-index: training set, 0.739; test set, 0.718). CONCLUSION: The nomogram was able to predict the risk of recurrence and can be easily applied in the clinical setting.
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