Format

Send to

Choose Destination
Ann Surg. 2018 Dec 21. doi: 10.1097/SLA.0000000000003162. [Epub ahead of print]

Metastatic Potential and Survival of Duodenal and Pancreatic Tumors in Multiple Endocrine Neoplasia Type 1: A GTE and AFCE Cohort Study (Groupe d'étude des Tumeurs Endocrines and Association Francophone de Chirurgie Endocrinienne).

Author information

1
INSERM, CIC1432, Clinical Epidemiology Unit, Dijon, France.
2
Dijon-Bourgogne University Hospital, Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials Unit, Dijon, France.
3
INSERM, U1231, Epidemiology and Clinical Research in Digestive Cancers Team, Dijon, France.
4
Burgundy-Franche-Comte University, UMR1231, Epidemiology and Clinical Research in Digestive Oncology Team, Dijon, France.
5
Department of Biostatistics and Medical Informatics, Dijon-Bourgogne University Hospital, Dijon, France.
6
Department of Endocrinology, Nantes University Hospital, Nantes, France.
7
Department of Digestive and Endocrine Surgery (Clinique de Chirurgie Digestive et Endocrinienne), Hôtel Dieu, CIC-IMAD, Nantes cedex 1, France.
8
Department of Endocrinology, Lille University Hospital, Lille, France.
9
Department of General and Endocrine Surgery, University Lille, INSERM U1190, Lille, France.
10
INSERM, U1149 and Department of Gastroenterology and Pancreatology, Beaujon Hospital, Clichy, France.
11
Department of Hepato-Pancreato-Biliary Surgery, Paris Diderot University, Beaujon Hospital, Clichy, France.
12
Inserm 1185, Paris-Sud University and Department of Endocrinology and Reproductive Diseases, Paris-Sud Hospital University, Bicêtre Hospital, Le Kremlin Bicêtre, France.
13
Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
14
Department of Oncologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France.
15
Department of General and Endocrine Surgery, APHP, Pitié-Salpétrière Hospital, Sorbonne University, Paris, France.
16
Department of Hepato-Pancreato-Biliary and Endocrine Surgery, Cochin University Hospital, APHP, Paris, France.
17
Department of Endocrinoloy, University Hospital of Lyon Sud and EA 7425 HESPER, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.
18
Department of Digestive and Endocrine Surgery, University Hospital of Lyon Sud and EA 7425 HESPER, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.
19
Department of Endocrinology, Toulouse University Hospital, Toulouse, France.
20
Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France.
21
Department of Endocrinogy, Bordeaux University Hospital, Bordeaux, France.
22
Department of Hepatobiliary Surgery, Bordeaux University Hospital, Bordeaux, France.
23
Department of Endocrinology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
24
Department of Digestive, Hepatobiliary, and Endocrine Surgery, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
25
Department of Medical Oncology Paoli-Calmettes Institute, Marseille, France.
26
Department of General, Endocrine and Metabolic Surgery, Conception Hospital, Marseille, France.
27
Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré Hospital, Reims-Champagne-Ardennes University, Reims, France.
28
Department of General and Digestive Surgery, Robert-Debré Hospital, Reims-Champagne-Ardennes University, Reims, France.
29
INSERM, CIC1432, Plurithematic Unit, Dijon, France.
30
Dijon-Bourgogne University Hospital, Clinical Investigation Centre, Plurithematic unit, Dijon, France.
31
Department of Digestive and Endocrine Surgery, Dijon University Hospital, Dijon, France.

Abstract

OBJECTIVE:

To assess the distant metastatic potential of duodeno-pancreatic neuroendocrine tumors (DP-NETs) in patients with MEN1, according to functional status and size.

SUMMARY BACKGROUND DATA:

DP-NETs, with their numerous lesions and endocrine secretion-related symptoms, continue to be a medical challenge; unfortunately they can become aggressive tumors associated with distant metastasis, shortening survival. The survival of patients with large nonfunctional DP-NETs is known to be poor, but the overall contribution of DP-NETs to metastatic spread is poorly known.

METHODS:

The study population included patients with DP-NETs diagnosed after 1990 and followed in the MEN1 cohort of the Groupe d'étude des Tumeurs Endocrines (GTE). A multistate Markov piecewise constant intensities model was applied to separate the effects of prognostic factors on 1) metastasis, and 2) metastasis-free death or 3) death after appearance of metastases.

RESULTS:

Among the 603 patients included, 39 had metastasis at diagnosis of DP-NET, 50 developed metastases during follow-up, and 69 died. The Markov model showed that Zollinger-Ellison-related tumors (regardless of tumor size and thymic tumor pejorative impact), large tumors over 2 cm, and age over 40 years were independently associated with an increased risk of metastases. Men, patients over 40 years old and patients with tumors larger than 2 cm, also had an increased risk of death once metastasis appeared.

CONCLUSIONS:

DP-NETs of 2 cm in size or more, regardless of the associated secretion, should be removed to prevent metastasis and increase survival. Surgery for gastrinoma remains debatable.

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center