Tsukasa Yoshida1,2, Susumu Hijioka3,4, Waki Hosoda5,6, Makoto Ueno7, Masayuki Furukawa8, Noritoshi Kobayashi9, Masafumi Ikeda10, Tetsuhide Ito11, Yuzo Kodama12, Chigusa Morizane13, Kenji Notohara14, Hiroki Taguchi15, Masayuki Kitano16, Kei Yane17, Yoshiaki Tsuchiya18, Izumi Komoto19, Hiroki Tanaka20, Akihito Tsuji21, Syunpei Hashigo22, Tetsuya Mine23, Atsushi Kanno24, Go Murohisa25, Katsuyuki Miyabe26, Tadayuki Takagi27, Nobutaka Matayoshi28, Masafumi Sakaguchi29, Hiroshi Ishii30,31, Yasushi Kojima32, Keitaro Matsuo33, Hideyuki Yoshitomi34, Shoji Nakamori35, Hiroaki Yanagimoto36, Yasushi Yatabe5, Junji Furuse37, Nobumasa Mizuno1. 1. Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. 2. Department of Gastroenterology, Kizawa Memorial Hospital, Minokamo, Japan. 3. Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. shijioka@ncc.go.jp. 4. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan. shijioka@ncc.go.jp. 5. Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan. 6. Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 7. Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan. 8. Department of Hepato-Biliary-Pancreatology, National Kyushu Cancer Center, Fukuoka, Japan. 9. Department of Oncology, Yokohama City University Hospital, Yokohama, Japan. 10. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan. 11. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 12. Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 13. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan. 14. Department of Anatomic Pathology, Kurashiki Central Hospital, Kurashiki, Japan. 15. Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. 16. Department of Gastroenterology and Hepatology, Kinki University, Faculty of Medicine, Sayama, Japan. 17. Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan. 18. Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata, Japan. 19. Department of Surgery, Kansai Electric Power Hospital, Osaka, Japan. 20. Department of Gastroenterology, Suzuka General Hospital, Suzuka, Japan. 21. Department of Medical Oncology, Kobe City Medical Center General Hospital, Kobe, Japan. 22. Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. 23. Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan. 24. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 25. Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan. 26. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 27. Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan. 28. Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. 29. Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan. 30. Department of Gastroenterology, Shikoku Cancer Center, Matsuyama, Japan. 31. Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 32. Department of Gastroenterology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan. 33. Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan. 34. Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan. 35. Department of Hepato-biliary-Pancreatic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. 36. Department of Surgery, Kansai Medical University Hospital, Maikata, Japan. 37. Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan.
Abstract
BACKGROUND: The role of surgery in pancreatic neuroendocrine neoplasm grade 3 (pNEN-G3) treatment remains unclear. We aimed to clarify the role of surgery for pNEN-G3, which has recently been reclassified as pancreatic neuroendocrine tumor-G3 (pNET-G3) and pancreatic neuroendocrine carcinoma-G3 (pNEC-G3), with and without metastases, respectively. METHODS: We analyzed a subgroup of patients from the Japanese pancreatic NEC study, a Japanese multicenter case-series study of pNEN-G3. Pathologists subclassified 67 patients as having pNET-G3 or pNEC-G3 based on morphological features. We compared the overall survival (OS) rates among patients who were grouped according to whether they had undergone tumor-targeted surgery for tumors without (SwoM) or with (SwM) metastases, or non-surgical procedures (NS). RESULTS: Data from 21 patients with pNET-G3 (SwoM, n = 6; SwM, n = 5; NS, n = 10) and 46 patients with pNEC-G3 (SwoM, n = 8; SwM, n = 5; NS, n = 33) were analyzed. OS of patients with pNET-G3 was significantly longer after SwoM and SwM than with NS (p = 0.018 and p = 0.022). In contrast, OS did not significantly differ between either SwoM or SwM and NS (p = 0.093 and p = 0.489) among patients with pNEC-G3. CONCLUSION: The role of surgery should be considered separately for pNET-G3 and pNEC-G3. Although SwoM and SwM can be considered for pNET-G3, caution is advised before considering SwM and SwoM for pNEC-G3.
BACKGROUND: The role of surgery in pancreatic neuroendocrine neoplasm grade 3 (pNEN-G3) treatment remains unclear. We aimed to clarify the role of surgery for pNEN-G3, which has recently been reclassified as pancreatic neuroendocrine tumor-G3 (pNET-G3) and pancreatic neuroendocrine carcinoma-G3 (pNEC-G3), with and without metastases, respectively. METHODS: We analyzed a subgroup of patients from the Japanese pancreatic NEC study, a Japanese multicenter case-series study of pNEN-G3. Pathologists subclassified 67 patients as having pNET-G3 or pNEC-G3 based on morphological features. We compared the overall survival (OS) rates among patients who were grouped according to whether they had undergone tumor-targeted surgery for tumors without (SwoM) or with (SwM) metastases, or non-surgical procedures (NS). RESULTS: Data from 21 patients with pNET-G3 (SwoM, n = 6; SwM, n = 5; NS, n = 10) and 46 patients with pNEC-G3 (SwoM, n = 8; SwM, n = 5; NS, n = 33) were analyzed. OS of patients with pNET-G3 was significantly longer after SwoM and SwM than with NS (p = 0.018 and p = 0.022). In contrast, OS did not significantly differ between either SwoM or SwM and NS (p = 0.093 and p = 0.489) among patients with pNEC-G3. CONCLUSION: The role of surgery should be considered separately for pNET-G3 and pNEC-G3. Although SwoM and SwM can be considered for pNET-G3, caution is advised before considering SwM and SwoM for pNEC-G3.
Authors: Ioannis A Ziogas; Panagiotis T Tasoudis; Luis C Borbon; Scott K Sherman; Patrick J Breheny; Chandrikha Chandrasekharan; Joseph S Dillon; Andrew M Bellizzi; James R Howe Journal: Ann Surg Oncol Date: 2022-10-13 Impact factor: 4.339