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Surgery. 2016 Mar;159(3):901-7. doi: 10.1016/j.surg.2015.10.003. Epub 2015 Nov 14.

Is the 2-cm size cutoff relevant for small nonfunctioning pancreatic neuroendocrine tumors: A French multicenter study.

Author information

1
Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif (IMAD), Hôtel Dieu, CHU de Nantes, Nantes, France. Electronic address: nicolas.regenet@chu-nantes.fr.
2
Service de Chirurgie Générale et Digestive, Hôpital Purpan, CHU de Toulouse, Toulouse, France.
3
Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif (IMAD), Hôtel Dieu, CHU de Nantes, Nantes, France.
4
Service de Chirurgie Digestive et Endocrine, Hôpital Trousseau, CHU de Tours, Tours, France.
5
Service de Chirurgie Viscérale et Endocrinienne Hôpital de la Miletrie, CHU de Poitiers, Poitiers, France.
6
Service de Chirurgie Digestive, Générale et Endocrinienne, Hôpital Dupuytren, CHU de Limoges, Limoges, France.
7
Service de Chirurgie Digestive et Viscérale, Hôpital Hautepierre, CHU de Strasbourg, Strasbourg, France.
8
Service de Chirurgie Viscérale, Hôpital Larrey, CHU d'Angers, Angers, France.

Abstract

BACKGROUND:

Nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) are often discovered at a small size. No clear consensus exists on the management of NF-PNETs ≤ 2 cm. The aim of our study was to determine the prognostic value of indicators of malignancy in sporadic NF-PNETs ≤ 2 cm.

METHODS:

Eighty patients were evaluated retrospectively in 7 French University Hospital Centers. Patients were managed by operative resection (operative group [OG]) or observational follow-up (non-OG [NOG]). Pathologic characteristics and outcomes were analyzed.

RESULTS:

Sixty-six patients (58% women) were in the OG (mean age, 59 years; 95% CI, 56.0-62.3; mean tumor size, 1.6 cm; 95% CI, 1.5-1.7); 14 (72% women, n = 10) were in the NOG (mean age, 63 years; 95% CI, 56-70; mean tumor size, 1.4 cm; 95% CI, 1.0-1.7). All PNETs were ranked using the European Neuroendocrine Tumor Society grading system. Fifteen patients (19%) had malignant tumors defined by node or liver metastasis (synchronous or metachronous). The median disease-free survival was different between malignant and nonmalignant PNETs, respectively: 16 (range, 4-72) versus 30 months (range, 1-156; P = .03). On a receiver operating characteristic (ROC) curve, tumor size had a significant impact on malignancy (area under the curve [AUC], 0.75; P = .03), but not Ki-67 (AUC, 0.59; P = .31). A tumor size cutoff was found on the ROC curve at 1.7 cm (odd ratio, 10.8; 95% CI; 2.2-53.2; P = .003) with a sensitivity of 92% and a specificity of 75% to predict malignancy.

CONCLUSION:

Based on our retrospective study, the cutoff of 2 cm of malignancy used for small NF-PNETs could be decreased to 1.7 cm to select patients more accurately.

PMID:
26590096
DOI:
10.1016/j.surg.2015.10.003
[Indexed for MEDLINE]

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