Medline ® Abstracts for References 3-5
of 'Surgical resection of sporadic pancreatic neuroendocrine tumors'
Clinicopathologic features and treatment trends of pancreatic neuroendocrine tumors: analysis of 9,821 patients.
Bilimoria KY, Tomlinson JS, Merkow RP, Stewart AK, Ko CY, Talamonti MS, Bentrem DJ
J Gastrointest Surg. 2007;11(11):1460.
The natural history of pancreatic neuroendocrine tumors (PNET) remains poorly defined. Our objectives were to examine the clinicopathologic features of PNETs, to assess treatment trends over time, and to identify factors associated with undergoing resection. From the National Cancer Data Base (1985-2004), 9,821 patients were identified with PNETs. Clinicopathologic features and treatment trends were examined. Multivariable logistic regression was used to assess factors associated with undergoing resection. Of 9,821 patients with PNETs, 85% were nonfunctional, 7.1% were functional, and 7.9% were carcinoid tumors. Of the 3,851 (39.0%) patients who underwent pancreatectomy, 449 (11.7%) received adjuvant chemotherapy, and 254 (6.6%) received adjuvant radiation. From 1985 to 2004, utilization of pancreatectomy increased from 39.4 to 44.3% (P<0.0001). Patients were less likely to undergo resection if they were>55 years old, had tumors in the head of the pancreas, tumors>or = 4 cm, or had distant metastases (P<0.0001). Patients treated at NCCN/NCI, academic, or high-volume hospitals were more likely to undergo resection. There are disparities in the utilization of pancreatectomy for PNETs. As PNETs have a better prognosis than adenocarcinoma, concerns regarding the morbidity and mortality of pancreatic surgery and neoplasms should not preclude resection.
Division of Surgical Oncology, Department of Surgery, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, 675 N. St. Clair, Galter 10-105, Chicago, IL 60611, USA.
Prognostic score predicting survival after resection of pancreatic neuroendocrine tumors: analysis of 3851 patients.
Bilimoria KY, Talamonti MS, Tomlinson JS, Stewart AK, Winchester DP, Ko CY, Bentrem DJ
Ann Surg. 2008;247(3):490.
BACKGROUND: Pancreatic neuroendocrine tumors (PNET) have a poorly defined natural history, and a staging system is not available. The objective of this study was to identify factors predicting survival after pancreatectomy for PNETs and to establish a postresection prognostic score.
PATIENTS AND METHODS: From the National Cancer Data Base (1985-2004), patients were identified who underwent PNET resection. Multivariable Cox proportional hazards modeling was used to assess the impact of patient, tumor, treatment, and hospital factors on survival. A prognostic score based on the predictive factors from the Cox model was developed.
RESULTS: Three thousand eight hundred fifty-one patients underwent resection for PNETs. Five-year overall survival was 59.3%, and the 10-year survival was 37.7%. On multivariable analysis, age, grade, distant metastases, tumor functionality, and type of resection were independent predictors of survival after resection of PNETs (P<0.0001). Gender, race, socioeconomic status, tumor size, nodal status, margins, adjuvant chemotherapy, and hospital volume were not associated with survival. Age, grade, and distant metastases were the most significant predictors of survival and were incorporated into a PNET postresection prognostic score. The prognostic score correlated with outcomes and offered excellent survival discrimination by each of the 3 score subgroups: 76.7%, 50.9%, and 35.7% (P<0.0001). The concordance index was 0.63 (95% CI 0.59-0.67), indicating reasonable agreement between actual outcomes and that predicted by the prognostic score.
CONCLUSIONS: The prognostic score can be used to predict outcomes, guide adjuvant treatment, and stratify patients for clinical trials.
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. email@example.com
Pancreatic neuroendocrine tumors: presentation, management, and outcomes.
Nissen NN, Kim AS, Yu R, Wolin EM, Friedman ML, Lo SK, Wachsman AM, Colquhoun SD
Am Surg. 2009;75(10):1025.
Pancreatic neuroendocrine tumors (pNETs) are an uncommon pancreatic neoplasm. We reviewed the presentation, management, and outcome of patients with pNETs treated at a single center by a multidisciplinary approach between 2004 and 2008. Over this time period, 154 patients with carcinoid and neuroendocrine tumors were treated, which included 46 patients (30% of total) with pNETs. The most common presentations included abdominal pain (20 of 46 [43%]), systemic symptoms such as hypoglycemia (15 of 46 [33%]), and incidental mass (7 of 46 [15%]). Fourteen patients had functional tumors. At the time of diagnosis, 22 patients (48%) presented without metastases and 24 (52%) had metastatic disease. Median follow up for the entire group was 42 months. All patients with nonmetastatic pNET underwent pancreatic resection with 95 per cent postoperative survival. Overall survival in this group at 3 years was 86 per cent and disease-free survival was 81 per cent. In patients presenting with metastatic pNET, multiple treatment modalities were used, including liver resection or ablation (n = 15), hepatic chemoembolization (n = 17), pancreatic resection (n = 12), and systemic treatments (n = 7). Three-year survival was 70 per cent. Pancreatic resection results in greater than 80 per cent 3-year survival in nonmetastatic pNET. In patients presenting with metastatic pNET, excellent survival rates are also achievable using a multidisciplinary multimodal approach.
Department of Surgery, Center for Liver Diseases and Transplantation, Cedars-Sinai Medical Center, 8635 W 3rd Street, Suite 590W, Los Angeles, CA 90048, USA. firstname.lastname@example.org