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J Clin Oncol. 2017 Jan 20;35(3):274-280. doi: 10.1200/JCO.2016.67.8193. Epub 2016 Sep 30.

Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems.

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Guopei Luo, Kaizhou Jin, Chen Liu, Jin Xu, Quanxing Ni, and Xianjun Yu, Fudan University Shanghai Cancer Center; Chenghao Shao, Shanghai Changzheng Hospital; Wei Wang, Huadong Hospital, Fudan University, Shanghai; Yu Zhang, Minhu Chen, and Jie Chen, The First Affiliated Hospital, Sun Yat-Sen University; Wei Wang, Sun Yat-sen University Cancer Center; Jian Sun, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou; Huangying Tan, China-Japan Friendship Hospital; and Jie Li and Lin Shen, Peking University Cancer Hospital and Institute, Beijing, China; Ammar Javed, Kevin Soares, Matthew J. Weiss, Lei Zheng, Christopher L. Wolfgang, and Jin He, The Johns Hopkins University School of Medicine, Baltimore, MD; and Jonathan R. Strosberg, Mauro Cives, and Joyce Wong, Moffitt Cancer Center and Research Institute, Tampa, FL.


Purpose The European Neuroendocrine Tumor Society (ENETS) and the American Joint Committee on Cancer (AJCC) staging classifications are two widely used systems in managing pancreatic neuroendocrine tumors. However, there is no universally accepted system. Methods An analysis was performed to evaluate the application of the ENETS and AJCC staging classifications using the SEER registry (N = 2,529 patients) and a multicentric series (N = 1,143 patients). A modified system was proposed based on analysis of the two existing classifications. The modified system was then validated. Results The proportion of patients with AJCC stage III disease was extremely low for both the SEER series (2.2%) and the multicentric series (2.1%). For the ENETS staging system, patients with stage I disease had a similar prognosis to patients with stage IIA disease, and patients with stage IIIB disease had a lower hazard ratio for death than did patients with stage IIIA disease. We modified the ENETS staging classification by maintaining the ENETS T, N, and M definitions and adopting the AJCC staging definitions. The proportion of patients with stage III disease using the modified ENETS (mENETS) system was higher than that of the AJCC system in both the SEER series (8.9% v 2.2%) and the multicentric series (11.6% v 2.1%). In addition, the hazard ratio of death for patients with stage III disease was higher than that for patients with stage IIB disease. Moreover, statistical significance and proportional distribution were observed in the mENETS staging classification. Conclusion An mENETS staging classification is more suitable for pancreatic neuroendocrine tumors than either the AJCC or ENETS systems and can be adopted in clinical practice.

[Indexed for MEDLINE]

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