Ding-Hui Dong1, Xu-Feng Zhang2, 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 Schmidt10, Mary Dillhoff10, Shishir K Maithel3, Timothy M Pawlik11. 1. Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 2. Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Division of Surgical Oncology, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA. 3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 4. Department of Surgery, Stanford University, Palo Alto, CA, USA. 5. Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA. 6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 7. Department of Surgery, Washington University School of Medicine, St. Louis, WI, USA. 8. Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, TN, USA. 9. Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. 10. Division of Surgical Oncology, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA. 11. Division of Surgical Oncology, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA. Electronic address: tim.pawlik@osumc.edu.
Abstract
BACKGROUND: To investigate the feasibility of Tumor Burden Score (TBS) to predict tumor recurrence following curative-intent resection of non-functional pancreatic neuroendocrine tumors (NF-pNETs). METHOD: The TBS cut-off values were determined by a statistical tool, X-tile. The influence of TBS on recurrence-free survival (RFS) was examined. RESULTS: Among 842 NF-pNETs patients, there was an incremental worsening of RFS as the TBS increased (5-year RFS, low, medium, and high TBS: 92.0%, 73.3%, and 59.3%, respectively; P < 0.001). TBS (AUC 0.74) out-performed both maximum tumor size (AUC 0.65) and number of tumors (AUC 0.5) to predict RFS (TBS vs. maximum tumor size, p = 0.05; TBS vs. number of tumors, p < 0.01). The impact of margin (low TBS: R0 80.4% vs. R1 71.9%, p = 0.01 vs. medium TBS: R0 55.8% vs. R1 37.5%, p = 0.67 vs. high TBS: R0 31.9% vs. R1 12.0%, p = 0.11) and nodal (5-year RFS, low TBS: N0 94.9% vs. N1 68.4%, p < 0.01 vs. medium TBS: N0 81.8% vs. N1 55.4%, p < 0.01 vs. high TBS: N0 58.0% vs. N1 54.2%, p = 0.15) status on 5-year RFS outcomes disappeared among patients who had higher TBS. CONCLUSIONS: TBS was strongly associated with risk of recurrence and outperformed both tumor size and number alone.
BACKGROUND: To investigate the feasibility of Tumor Burden Score (TBS) to predict tumor recurrence following curative-intent resection of non-functional pancreatic neuroendocrine tumors (NF-pNETs). METHOD: The TBS cut-off values were determined by a statistical tool, X-tile. The influence of TBS on recurrence-free survival (RFS) was examined. RESULTS: Among 842 NF-pNETs patients, there was an incremental worsening of RFS as the TBS increased (5-year RFS, low, medium, and high TBS: 92.0%, 73.3%, and 59.3%, respectively; P < 0.001). TBS (AUC 0.74) out-performed both maximum tumor size (AUC 0.65) and number of tumors (AUC 0.5) to predict RFS (TBS vs. maximum tumor size, p = 0.05; TBS vs. number of tumors, p < 0.01). The impact of margin (low TBS: R0 80.4% vs. R1 71.9%, p = 0.01 vs. medium TBS: R0 55.8% vs. R1 37.5%, p = 0.67 vs. high TBS: R0 31.9% vs. R1 12.0%, p = 0.11) and nodal (5-year RFS, low TBS: N0 94.9% vs. N1 68.4%, p < 0.01 vs. medium TBS: N0 81.8% vs. N1 55.4%, p < 0.01 vs. high TBS: N0 58.0% vs. N1 54.2%, p = 0.15) status on 5-year RFS outcomes disappeared among patients who had higher TBS. CONCLUSIONS: TBS was strongly associated with risk of recurrence and outperformed both tumor size and number alone.
Authors: Aryana M Razmara; Luke A Wittenburg; Sami Al-Nadaf; Ryan G Toedebusch; Frederick J Meyers; Christine M Toedebusch Journal: Front Oncol Date: 2022-05-27 Impact factor: 5.738
Authors: Charlotte M Heidsma; Diamantis I Tsilimigras; Flavio Rocha; Daniel E Abbott; Ryan Fields; George A Poultsides; Clifford S Cho; Alexandra G Lopez-Aguiar; Zaheer Kanji; Alexander V Fisher; Bradley A Krasnick; Kamran Idrees; Eleftherios Makris; Megan Beems; Casper H J van Eijck; Elisabeth J M Nieveen van Dijkum; Shishir K Maithel; Timothy M Pawlik Journal: Cancers (Basel) Date: 2021-05-07 Impact factor: 6.639
Authors: Ashley L Titan; Jeffrey A Norton; Andrea T Fisher; Deshka S Foster; E John Harris; David J Worhunsky; Patrick J Worth; Monica M Dua; Brendan C Visser; George A Poultsides; Michael T Longaker; Robert T Jensen Journal: JAMA Netw Open Date: 2020-11-02