TY - JOUR
T1 - A novel tool to predict nodal metastasis in small pancreatic neuroendocrine tumors
T2 - A multicenter study
AU - Pancreatic Neuroendocrine Disease Alliance (PANDA)
AU - Javed, Ammar A.
AU - Pulvirenti, Alessandra
AU - Zheng, Jian
AU - Michelakos, Theodoros
AU - Sekigami, Yurie
AU - Razi, Samrah
AU - McIntyre, Caitlin A.
AU - Thompson, Elizabeth
AU - Klimstra, David S.
AU - Deshpande, Vikram
AU - Singhi, Aatur D.
AU - Weiss, Matthew J.
AU - Wolfgang, Christopher L.
AU - Cameron, John L.
AU - Wei, Alice C.
AU - Zureikat, Amer H.
AU - Ferrone, Cristina R.
AU - He, Jin
AU - Burkhart, Richard A.
AU - Burns, William R.
AU - Makary, Marty A.
AU - Fishman, Elliot K.
AU - Hruban, Ralph H.
AU - Kingham, T. Peter
AU - D'Angelica, Michael
AU - Balachandran, Vinod P.
AU - Drebin, Jeff
AU - Soares, Kevin C.
AU - Jarnagin, William R.
AU - Fernandez del Castillo, Carlos
AU - Lillemoe, Keith
AU - Qadan, Motaz
AU - Paniccia, Alessandro
AU - Lee, Kenneth K.
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/12
Y1 - 2022/12
N2 - Background: Nonfunctional pancreatic neuroendocrine tumors display a wide range of biological behavior, and nodal disease is associated with metastatic disease and poorer survival. The aim of this study was to develop a tool to predict nodal disease in patients with small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors. Methods: A multicenter retrospective study was performed on patients undergoing resection for small nonfunctional pancreatic neuroendocrine tumors. Patients with genetic syndromes, metastatic disease at diagnosis, neoadjuvant therapy, or positive resection margin were excluded. Factors associated with nodal disease were identified to develop a predictive model. Internal validation was performed using bootstrap with 1,000 resamples. Results: Nodal disease was observed in 39 (11.1%) of the 353 patients included. Presence of nodal disease was significantly associated with lower 5-year disease-free survival (71.6% vs 96.2%, P <.001). Two predictors were strongly associated with nodal disease: G2 grade (odds ratio: 3.51, 95% confidence interval: 1.71–7.22, P =.001) and tumor size (per mm increase, odds ratio: 1.14, 95% confidence interval: 1.03–1.25, P =.009). Adequate discrimination was observed with an area under the curve of 0.71 (95% confidence interval: 0.63–0.80). Based on risk distribution, 3 risk groups of nodal disease were identified; low (<5%), intermediate (≥5% to <20%), and high (≥20%) risk. The observed mean risk of nodal disease was 3.7% in the low-risk patients, 9.6% in the intermediate-risk patients, and 30.4% in the high-risk patients (P <.001). The 10-year disease-free survival in the low, intermediate, and high-risk groups was 100%, 88.8%, and 50.1%, respectively. Conclusion: Our model using tumor grade and size can predict nodal disease in small nonfunctional pancreatic neuroendocrine tumors. Integration of this tool into clinical practice could help guide management of these patients.
AB - Background: Nonfunctional pancreatic neuroendocrine tumors display a wide range of biological behavior, and nodal disease is associated with metastatic disease and poorer survival. The aim of this study was to develop a tool to predict nodal disease in patients with small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors. Methods: A multicenter retrospective study was performed on patients undergoing resection for small nonfunctional pancreatic neuroendocrine tumors. Patients with genetic syndromes, metastatic disease at diagnosis, neoadjuvant therapy, or positive resection margin were excluded. Factors associated with nodal disease were identified to develop a predictive model. Internal validation was performed using bootstrap with 1,000 resamples. Results: Nodal disease was observed in 39 (11.1%) of the 353 patients included. Presence of nodal disease was significantly associated with lower 5-year disease-free survival (71.6% vs 96.2%, P <.001). Two predictors were strongly associated with nodal disease: G2 grade (odds ratio: 3.51, 95% confidence interval: 1.71–7.22, P =.001) and tumor size (per mm increase, odds ratio: 1.14, 95% confidence interval: 1.03–1.25, P =.009). Adequate discrimination was observed with an area under the curve of 0.71 (95% confidence interval: 0.63–0.80). Based on risk distribution, 3 risk groups of nodal disease were identified; low (<5%), intermediate (≥5% to <20%), and high (≥20%) risk. The observed mean risk of nodal disease was 3.7% in the low-risk patients, 9.6% in the intermediate-risk patients, and 30.4% in the high-risk patients (P <.001). The 10-year disease-free survival in the low, intermediate, and high-risk groups was 100%, 88.8%, and 50.1%, respectively. Conclusion: Our model using tumor grade and size can predict nodal disease in small nonfunctional pancreatic neuroendocrine tumors. Integration of this tool into clinical practice could help guide management of these patients.
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U2 - 10.1016/j.surg.2022.08.022
DO - 10.1016/j.surg.2022.08.022
M3 - Article
C2 - 36192215
AN - SCOPUS:85139314419
SN - 0039-6060
VL - 172
SP - 1800
EP - 1806
JO - Surgery (United States)
JF - Surgery (United States)
IS - 6
ER -