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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

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



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.


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).


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.


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.

[Available on 2019-01-01]
[Indexed for MEDLINE]

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