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. 2018 Feb;42(2):490-497.
doi: 10.1007/s00268-017-4278-y.

A Nationwide Population-Based Study on the Survival of Patients with Pancreatic Neuroendocrine Tumors in The Netherlands

C G Genc  1 , H J Klümpen  2   3 , M G H van Oijen  2   3   4 , C H J van Eijck  5 , E J M Nieveen van Dijkum  6
Affiliations

A Nationwide Population-Based Study on the Survival of Patients with Pancreatic Neuroendocrine Tumors in The Netherlands

C G Genc et al. World J Surg. 2018 Feb.

Abstract

Background: Large population-based studies give insight into the prognosis and treatment outcomes of patients with pancreatic neuroendocrine tumors (pNETs). Therefore, we provide an overview of the treatment and related survival of pNET in the Netherlands.

Methods: Patients diagnosed with pNET between 2008 and 2013 from the Netherlands Cancer Registry were included. Patient, tumors and treatment characteristics were reported. Survival analyses with log-rank testing were performed to compare survival.

Results: In total, 611 patients were included. Median follow-up was 25.7 months, and all-cause mortality was 42%. Higher tumor grade and TNM stage were significantly associated with worse survival in both the overall and metastasized population. The effect of distant metastases on survival was more significant in lower tumor stages (T1-3 p < 0.05, T4 p = 0.074). Resection of the primary tumor was performed in 255 (42%) patients. Patients who underwent surgery had the highest 5-year survival (86%) compared to PRRT (33%), chemotherapy (21%), targeted therapy and somatostatin analogs (24%) (all p < 0.001). Patients with T1M0 tumors (n = 115) showed favorable survival after surgical resection (N = 95) compared to no therapy (N = 20, p = 0.008). Resection also improved survival significantly in patients with metastases compared to other treatments (all p > 0.05). Without surgery, PRRT showed the best survival curves in patients with distant metastases. Grade 3 tumors and surgical resection were independently associated with survival (HR 7.23 and 0.12, respectively).

Conclusion: Surgical resection shows favorable outcome for all pNET tumors, including indolent tumors and tumors with distant metastases. Prospective trials should be initiated to confirm these results.

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Conflict of interest statement

All the authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Overall survival of patients with different tumor grades. a Overall patient population. b Patient with metastatic disease
Fig. 2
Fig. 2
Overall survival of patients with different tumor stages. a Overall patient population. b Patients with metastatic disease. No significant difference in survival was seen between each tumor stage
Fig. 3
Fig. 3
Overall survival of patients based on first-line treatment a all patients. Surgical resection showed significantly superior survival compared to the other treatments (all p < 0.001). b Patients with distant metastases
Fig. 4
Fig. 4
Survival of patients with T1M0 tumors
See this image and copyright information in PMC

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