M1557 Survival Impact of Malignant Pancreatic Neuroendocrine and Islet Cell Neoplasm Phenotypes

Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9155, USA.
Journal of Surgical Oncology (Impact Factor: 3.24). 05/2009; 105(6):595-600. DOI: 10.1002/jso.22118
Source: PubMed


The low incidence of malignant "functional" (F) or "nonfunctional" (NF) neuroendocrine islet cell tumors (ICTs) of the pancreas represents a challenge to precise post-therapeutic survival prediction. This study examined the survival impact of malignant pancreatic ICT morphologic subtypes.
A pancreatic ICT data set was created from a US-based population database from 1980-2004. Prognostic factors with survival impact and relationships between surgical therapy and overall survival (OS) were analyzed.
There were 2,350 individuals with malignant ICTs. Histologic subtypes included carcinoid tumors, islet cell carcinomas, neuroendocrine carcinomas, and malignant gastrinomas, insulinomas, glucagonomas, or VIPomas. There was no difference in resection rates between FICTs and NFICTs (23% vs. 20%, P = ns). Median OS was 30 months, with group differences ranging from NE carcinomas (21) to VIPomas (96; P < 0.0001). Median OS of resected versus unresected FICTs was 172 versus 37 months, while that of NFICTs was 113 versus 18 months (P < 0.0001). Compared to neuroendocrine carcinomas, hazard ratios were: VIPomas 0.48, gastrinomas 0.65, carcinoid tumors 0.76, insulinomas 0.84, glucagonomas 0.93, and islet cell carcinomas 1.0.
When controlled for other established prognostic parameters, histopathologic subtype assignment of pancreatic ICTs affects survival prediction. Resection is associated with superior survival for all tumor types.

15 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hypothesis: Lymph node metastases decrease survival in patients with pancreatic neuroendocrine tumors (pNETs). Design: Prospective database searches. Setting: National Institutes of Health (NIH) and Stanford University Hospital (SUH). Patients: A total of 326 patients underwent surgical exploration for pNETs at the NIH (n=216) and SUH (n=110). Main Outcome Measures: Overall survival, diseaserelated survival, and time to development of liver metastases. Results: Forty patients (12.3%) underwent enucleation and 305 (93.6%) underwent resection. Of the patients who underwent resection, 117 (35.9%) had partial pancreatectomy and 30 (9.2%) had a Whipple procedure. Forty-one patients also had liver resections, 21 had wedge resections, and 20 had lobectomies. Mean follow-up was 8.1 years (range, 0.3-28.6 years). The 10-year overall survival for patients with no metastases or lymph node metastases only was similar at 80%. As expected, patients with liver metastases had a significantly decreased 10-year survival of 30% (P<.001). The time to development of liver metastases was significantly reduced for patients with lymph node metastases alone compared with those with none (P<.001). For the NIH cohort with longer follow-up, disease-related survival was significantly different for those patients with no metastases, lymph node metastases alone, and liver metastases (P<.001). Extent of lymph node involvement in this subgroup showed that disease-related survival decreased as a function of the number of lymph nodes involved (P=.004). Conclusions: As expected, liver metastases decrease survival of patients with pNETs. Patients with lymph node metastases alone have a shorter time to the development of liver metastases that is dependent on the number of lymph nodes involved. With sufficient long-term follow-up, lymph node metastases decrease diseaserelated survival. Careful evaluation of number and extent of lymph node involvement is warranted in all surgical procedures for pNETs.
    No preview · Article · Sep 2012 · Archives of surgery (Chicago, Ill.: 1960)
  • [Show abstract] [Hide abstract]
    ABSTRACT: : Laparoscopic distal pancreatectomy (LDP) is a reliable and safe operation for selected patients with benign and low-grade malignant lesions in the body and tail of the pancreas. However, its application for malignant disease has been rarely reported. The aim of this study is to analyze postoperative outcomes of the patients with a diagnosis of benign or borderline malignancy, who were postoperatively diagnosed as malignancy after LDP. : From January 2005 to March 2011, LDP was performed on 88 patients, and 11 were subsequently diagnosed as malignancy in postoperative pathologic reports. A retrospective analysis of the clinical outcomes of these 11 patients was conducted. : The patients were 4 men and 7 women with a median age of 68 years (range, 29 to 83 y). The postoperative diagnoses were 5 with ductal adenocarcinoma, 3 with invasive intraductal papillary mucinous neoplasm, 1 with mucinous cystadenocarcinoma, 1 with neuroendocrine carcinoma, and 1 with pancreas metastasis from a renal cell carcinoma. The median operation time was 180 minutes (range, 80 to 325 min), and the median estimated blood loss was 200 mL (range, 150 to 500 mL). There were no open conversions. Four (36%) patients experienced complications: intra-abdominal fluid collection (2), spleen infarction (1), and enterocutaneous fistula (1). The median postoperative hospital stay was 11 days (range, 6 to 18 d). All the patients were considered to have curative resection (R0), postoperatively. During the median follow-up period of 30 months (range, 3 to 58 mo), 1 patient was found to have liver metastasis, which had been present and misdiagnosed as benign hemangioma on preoperative diagnostic workup. This patient died 1 year after LDP. Another patient was found to have liver metastasis 30 months after LDP. The patient was treated with radiofrequency ablation, and he was still alive 60 months postoperatively. The remaining patients were alive without any recurrent disease. : The postoperative outcomes of the patients, who were diagnosed postoperatively as having a malignant pancreatic disease, are acceptable.
    No preview · Article · Oct 2012 · Surgical laparoscopy, endoscopy & percutaneous techniques
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to identify management strategies for non-functioning pancreatic neuroendocrine tumours (NF-PNETs) by analysis of surgical outcomes at a single institution. Archived records of patients with NF-PNETs who underwent surgery between 1994 and 2010 were reviewed. Among 125 patients, the median tumour size was 2·5 (range 0·15-20·5) cm. Of the 51 NF-PNETs with a diameter of no more than 2 cm, 12 (24 per cent) were diagnosed as carcinoma. Overall 20 patients (16·0 per cent) had metastases to the lymph nodes. The minimum size of the tumour with lymph node metastasis was 1·2 cm. Having a NF-PNET of 2 cm or larger significantly increased the probability of a poorly differentiated carcinoma (P = 0·006), and having a NF-PNET of at least 2·5 cm significantly increased the probability of lymph node metastasis (P = 0·048). The 5-year cumulative survival rate after curative resection was 89·7 per cent. During a median follow-up of 31·5 months, there were 27 recurrences (23·1 per cent) and 13 disease-specific deaths (11·1 per cent) among the 117 patients who had an R0 resection. All patients who underwent repeat operations were alive without additional recurrence after a mean(s.d.) follow-up of 27·1(18·0) months. Curative surgery should be performed for control of primary NF-PNETs. Lymph node dissection for NF-PNETs of 2·5 cm or larger and at least node sampling for tumours with a diameter of 1 cm or more are recommended. Debulking surgery should be considered for advanced tumours. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
    No preview · Article · Nov 2012 · British Journal of Surgery
Show more