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J Surg Oncol. 2019 Dec;120(7):1071-1079. doi: 10.1002/jso.25716. Epub 2019 Sep 30.

Impact of tumor size and nodal status on recurrence of nonfunctional pancreatic neuroendocrine tumors ≤2 cm after curative resection: A multi-institutional study of 392 cases.

Author information

1
Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
2
Division of Surgical Oncology, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
3
Department of Surgery, Stanford University, Palo Alto, California.
4
Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.
5
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
6
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
7
Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, Tennessee.
8
Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
9
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.

Abstract

BACKGROUND:

The current study sought to define the impact of lymph node metastasis (LNM) relative to tumor size on tumor recurrence after curative resection for nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) ≤2 cm.

METHODS:

Patients who underwent curative resection for ≤2-cm NF-pNETs were identified from a multi-institutional database. Risk factors associated with tumor recurrence as well as LNM were identified. Recurrence-free survival (RFS) was compared among patients with or without LNM.

RESULTS:

A total of 392 ≤2-cm NF-pNETs patients were identified. Among the 328 patients who had lymph node dissection and evaluation, 42 (12.8%) patients had LNM. LNM was associated with tumor recurrence (hazard ratio, 3.06; P = .026) after surgery. RFS was worse among LNM vs no LNM patients (5-year RFS, 81.7% vs 94.1%; P = .019). Patients with tumors measuring 1.5-2 cm had a two-fold increase in the incidence of LNM vs patients with tumors <1.5 cm (17.9% vs 8.7%, odds ratio, 2.59; P = .022), as well as a higher risk of advanced tumor grade and higher Ki-67 levels (both P < .01). After curative resection, a total of 14 (8.0%) patients with a tumor of 1.5-2 cm and 10 (4.5%) patients with tumor <1.5 cm developed tumor recurrence.

CONCLUSION:

Surgical resection with lymphadenectomy should be considered for patients with NF-pNETs ≥1.5-2.0 cm.

KEYWORDS:

lymph node metastasis; neuroendocrine tumor; pancreas; surgery; tumor size

PMID:
31571225
DOI:
10.1002/jso.25716
[Indexed for MEDLINE]

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