F Ausania1, P Senra Del Rio2, M A Gomez-Bravo3, E Martin-Perez4, J A Pérez-Daga5, D Dorcaratto6, T González-Nicolás7, S Sanchez-Cabus8, A Tardio-Baiges9. 1. HPB Surgery Unit, Department of Surgery, Complejo Hospitalario Universitario de Vigo, Spain. Electronic address: f.ausania@googlemail.com. 2. HPB Surgery Unit, Department of Surgery, Complejo Hospitalario Universitario de Vigo, Spain. 3. HPB Surgery Unit, Department of Surgery, Hospital Virgen del Rocio, Sevilla, Spain. 4. HPB Surgery Unit, Department of Surgery, Hospital La Princesa, Madrid, Spain. 5. HPB Surgery Unit, Department of Surgery, Hospital Carlos Haya, Malaga, Spain. 6. HPB Surgery Unit, Department of Surgery, Hospital Clínico Universitario, Valencia, Spain. 7. HPB Surgery Unit, Department of Surgery, Hospital Miguel Servet, Zaragoza, Spain. 8. HPB Surgery Unit, Department of Surgery, Hospital Clinic, Barcelona, Spain. 9. Pathology Department, Complejo Hospitalario Universitario de Vigo, Spain.
Abstract
INTRODUCTION: Pancreatic neuroendocrine neoplasms (PNEN) are rare tumours and well differentiated PNEN are associated with relatively indolent physiological behaviour. For this reason, only few studies have investigated those factors associated with recurrence in this group of patients. The aim of this study is to analyse whether it is possible to predict tumour recurrence in World Health Organization (WHO) 2017 G1-G2 PNEN patients. METHODS: This is a retrospective multi-institutional study. Patients submitted to pancreatic resection from 7 Spanish centres were reviewed. Only patients with WHO G1-G2 PNEN were included. Demographic and clinicopathological variables were analysed. RESULTS: Data from 137 patients were reviewed. Median age was 59.2 (25-84) years. Recurrence of disease occurred in 19 (13.9%) patients. Median DFS was 55 months. At multivariate analysis, tumour size >20 mm, lymphnode metastasis and a new tumour grade 2 incorporating Ki-67 labelling index (LI) > 5% and mitotic index (MI) > 2 were independently associated with recurrence. We developed a risk score model with these three factors. High-risk patients had a significantly lower 5-year disease-specific survival compared to low-risk patients (70% vs 100%). CONCLUSION: We propose a novel risk score for recurrence based on lymphnode metastasis, tumour size > 20 mm and a new grade 2 based on Ki-67 LI >5% and MI > 2. If 2 factors are present, patients have a higher risk for recurrence and a significantly poorer DSS, and therefore they should be closely monitored during follow-up. The role of adjuvant chemotherapy in these patients needs to be evaluated in clinical trials.
INTRODUCTION:Pancreatic neuroendocrine neoplasms (PNEN) are rare tumours and well differentiated PNEN are associated with relatively indolent physiological behaviour. For this reason, only few studies have investigated those factors associated with recurrence in this group of patients. The aim of this study is to analyse whether it is possible to predict tumour recurrence in World Health Organization (WHO) 2017 G1-G2 PNEN patients. METHODS: This is a retrospective multi-institutional study. Patients submitted to pancreatic resection from 7 Spanish centres were reviewed. Only patients with WHO G1-G2 PNEN were included. Demographic and clinicopathological variables were analysed. RESULTS: Data from 137 patients were reviewed. Median age was 59.2 (25-84) years. Recurrence of disease occurred in 19 (13.9%) patients. Median DFS was 55 months. At multivariate analysis, tumour size >20 mm, lymphnode metastasis and a new tumour grade 2 incorporating Ki-67 labelling index (LI) > 5% and mitotic index (MI) > 2 were independently associated with recurrence. We developed a risk score model with these three factors. High-risk patients had a significantly lower 5-year disease-specific survival compared to low-risk patients (70% vs 100%). CONCLUSION: We propose a novel risk score for recurrence based on lymphnode metastasis, tumour size > 20 mm and a new grade 2 based on Ki-67 LI >5% and MI > 2. If 2 factors are present, patients have a higher risk for recurrence and a significantly poorer DSS, and therefore they should be closely monitored during follow-up. The role of adjuvant chemotherapy in these patients needs to be evaluated in clinical trials.
Authors: Masayuki Tanaka; Max Heckler; André L Mihaljevic; Pascal Probst; Ulla Klaiber; Ulrike Heger; Simon Schimmack; Markus W Büchler; Thilo Hackert Journal: Ann Surg Oncol Date: 2020-07-27 Impact factor: 5.344
Authors: Angela Lamarca; Hamish Clouston; Jorge Barriuso; Mairéad G McNamara; Melissa Frizziero; Was Mansoor; Richard A Hubner; Prakash Manoharan; Sarah O'Dwyer; Juan W Valle Journal: J Clin Med Date: 2019-10-05 Impact factor: 4.241