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Risk Factors for Recurrence in Pancreatic Neuroendocrine Tumor and Size as a Surrogate in Determining the Treatment Strategy: A Korean Nationwide Study

 Wooil Kwon  ;  Jin-Young Jang  ;  Ki Byung Song  ;  Dae Wook Hwang  ;  Song Cheol Kim  ;  Jin Seok Heo  ;  Dong Wook Choi  ;  Ho Kyoung Hwang  ;  Chang Moo Kang  ;  Yoo-Seok Yoon  ;  Ho-Seong Han  ;  Joon Seong Park  ;  Tae Ho Hong  ;  Chol Kyoon Cho  ;  Keun Soo Ahn  ;  Huisong Lee  ;  Seung Eun Lee  ;  Chi-Young Jeong  ;  Young Hoon Roh  ;  Hee Joon Kim 
 NEUROENDOCRINOLOGY, Vol.111(8) : 794-804, 2021-07 
Journal Title
Issue Date
Adult ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local* / epidemiology ; Neoplasm Recurrence, Local* / pathology ; Neoplasm Recurrence, Local* / therapy ; Neuroendocrine Tumors* / epidemiology ; Neuroendocrine Tumors* / pathology ; Neuroendocrine Tumors* / therapy ; Pancreatic Neoplasms* / epidemiology ; Pancreatic Neoplasms* / pathology ; Pancreatic Neoplasms* / therapy ; Republic of Korea / epidemiology ; Risk Factors
Neuroendocrine tumor ; Pancreas ; Recurrence ; Risk factor ; Treatment algorithm
Introduction: The prognostic factors of pancreatic neuroendocrine tumor (PNET) are unclear, and the treatment guidelines are insufficient. This study aimed to suggest a treatment algorithm for PNET based on risk factors for recurrence in a large cohort.

Methods: Data of 918 patients who underwent curative intent surgery for PNET were collected from 14 tertiary centers. Risk factors for recurrence and survival analyses were performed.

Results: The 5-year disease-free survival (DFS) rate was 86.5%. Risk factors for recurrence included margin status (R1, hazard ratio [HR] 2.438; R2, HR 3.721), 2010 WHO grade (G2, HR 3.864; G3, HR 7.352), and N category (N1, HR 2.273). A size of 2 cm was significant in the univariate analysis (HR 8.511) but not in the multivariate analysis (p = 0.407). Tumor size was not a risk factor for recurrence, but strongly reflected 2010 WHO grade and lymph node (LN) status. Tumors ≤2 cm had lower 2010 WHO grade, less LN metastasis (p < 0.001), and significantly longer 5-year DFS (77.9 vs. 98.2%, p < 0.001) than tumors >2 cm. The clinicopathologic features of tumors <1 and 1-2 cm were similar. However, the LN metastasis rate was 10.3% in 1-2-cm sized tumors and recurrence occurred in 3.0%. Tumors <1 cm in size did not have any LN metastasis or recurrence.

Discussion/conclusion: Radical surgery is needed in suspected LN metastasis or G3 PNET or tumors >2 cm. Surveillance for <1-cm PNETs should be sufficient. Tumors sized 1-2 cm require limited surgery with LN resection, but should be converted to radical surgery in cases of doubtful margins or LN metastasis.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Park, Joon Seong(박준성) ORCID logo https://orcid.org/0000-0001-8048-9990
Hwang, Ho Kyoung(황호경) ORCID logo https://orcid.org/0000-0003-4064-7776
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