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Multicenter Study
. 2019 Dec;120(7):1071-1079.
doi: 10.1002/jso.25716. Epub 2019 Sep 30.

Impact of tumor size and nodal status on recurrence of nonfunctional pancreatic neuroendocrine tumors ≤2 cm after curative resection: A multi-institutional study of 392 cases

Ding-Hui Dong  1 , Xu-Feng Zhang  1   2 , George Poultsides  3 , Flavio Rocha  4 , Sharon Weber  5 , Ryan Fields  6 , Kamran Idrees  7 , Cliff Cho  8 , Shishir K Maithel  9 , Timothy M Pawlik  2 ; other members of the US Neuroendocrine Tumor Study Group
Affiliations
Multicenter Study

Impact of tumor size and nodal status on recurrence of nonfunctional pancreatic neuroendocrine tumors ≤2 cm after curative resection: A multi-institutional study of 392 cases

Ding-Hui Dong et al. J Surg Oncol. 2019 Dec.

Abstract

Background: The current study sought to define the impact of lymph node metastasis (LNM) relative to tumor size on tumor recurrence after curative resection for nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) ≤2 cm.

Methods: Patients who underwent curative resection for ≤2-cm NF-pNETs were identified from a multi-institutional database. Risk factors associated with tumor recurrence as well as LNM were identified. Recurrence-free survival (RFS) was compared among patients with or without LNM.

Results: A total of 392 ≤2-cm NF-pNETs patients were identified. Among the 328 patients who had lymph node dissection and evaluation, 42 (12.8%) patients had LNM. LNM was associated with tumor recurrence (hazard ratio, 3.06; P = .026) after surgery. RFS was worse among LNM vs no LNM patients (5-year RFS, 81.7% vs 94.1%; P = .019). Patients with tumors measuring 1.5-2 cm had a two-fold increase in the incidence of LNM vs patients with tumors <1.5 cm (17.9% vs 8.7%, odds ratio, 2.59; P = .022), as well as a higher risk of advanced tumor grade and higher Ki-67 levels (both P < .01). After curative resection, a total of 14 (8.0%) patients with a tumor of 1.5-2 cm and 10 (4.5%) patients with tumor <1.5 cm developed tumor recurrence.

Conclusion: Surgical resection with lymphadenectomy should be considered for patients with NF-pNETs ≥1.5-2.0 cm.

Keywords: lymph node metastasis; neuroendocrine tumor; pancreas; surgery; tumor size.

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Conflict of interest statement

CONFLICT OF INTERESTS

The authors declare that there is no conflict of interests.

Figures

FIGURE 1
FIGURE 1
Recurrence-free survival of patients with or without lymph nodal metastasis (LNM) in the whole cohort (n = 392)
FIGURE 2
FIGURE 2
A, Incidence of lymph node metastasis (LNM) among patients with tumor <1.5 cm vs patients with a tumor of 1.5–2 cm. The total number of lymph nodes examined (B) and the number of LNM (C) of each patient in the two differently sized tumor groups
FIGURE 3
FIGURE 3
A, Recurrence-free survival of patients with different tumor size (<1.5 cm, n = 221 vs 1.5–2 cm, n = 171). B, Recurrence patterns among patients with tumor <1.5 cm vs patients with tumor of 1.5–2 cm after curative resection
See this image and copyright information in PMC

References

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