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J Clin Endocrinol Metab. 2018 Jan 1;103(1):187-195. doi: 10.1210/jc.2017-01791.

A Lymph Node Ratio-Based Staging Model Is Superior to the Current Staging System for Pancreatic Neuroendocrine Tumors.

Author information

1
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
2
Department of Surgery, Democritus University of Thrace Medical School, Alexandroupoli, Greece.
3
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
4
Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.

Abstract

Context:

The incidence of pancreatic neuroendocrine tumors (PNETs) is increasing. Current staging systems include nodal positivity, but the association of lymph node status and worse survival is controversial.

Objective:

The study aim was to determine the prognostic significance of lymph node ratio (LNR) and compare it with nodal positivity for PNET.

Design, Setting, Participants, and Intervention:

A retrospective analysis of the Surveillance, Epidemiology, and End Results database between 2004 and 2011 was performed in patients who underwent a pancreatectomy with lymphadenectomy. The primary outcome was disease-specific survival (DSS).

Results:

Of the 896 patients analyzed, T stage, N stage, distant metastasis, grade, extent of resection, sex, and age ≥57 years were significantly associated with worse DSS on univariate analysis. On multivariate analysis, age ≥57 [hazard ratio (HR) 1.75, 95% confidence interval (CI), 1.12 to 2.74, P = 0.015], male sex (HR 1.58; 95% CI, 1.01 to 2.48; P = 0.046), grade (poorly differentiated/undifferentiated: HR 7.59; 95% CI, 4.71 to 12.23; P < 0.001), distant metastases (HR 2.45; 95% CI, 1.58 to 3.79; P < 0.001), and partial pancreatectomy (HR 2.55; 95% CI, 1.2 to 5.4; P = 0.015) were associated with worse DSS. Comparison between staging models constructed based on LNR cutoffs and the American Joint Committee on Cancer (AJCC) eighth edition staging system revealed that a model based on LNR ≥0.5 was superior.

Conclusions:

LNR ≥0.5 is independently associated with worse DSS. A staging system with LNR ≥0.5 was superior to the current AJCC eighth edition staging system.

PMID:
29069375
PMCID:
PMC5761495
[Available on 2019-01-01]
DOI:
10.1210/jc.2017-01791
[Indexed for MEDLINE]

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