Risk Factors for Recurrence in Pancreatic Neuroendocrine Tumor and Size as a Surrogate in Determining the Treatment Strategy: A Korean Nationwide Study
- Kwon, Wooil; Jang, Jin-Young; Song, Ki Byung; Hwang, Dae Wook; Kim, Song Cheol; Heo, Jin Seok; Choi, Dong Wook; Hwang, Ho Kyoung; Kang, Chang Moo; Yoon, Yoo-Seok; Han, Ho-Seong; Park, Joon Seong; Hong, Tae Ho; Cho, Chol Kyoon; Ahn, Keun Soo; Lee, Huisong; Lee, Seung Eun; Jeong, Chi-Young; Roh, Young Hoon; Kim, Hee Joon
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- Pancreas; Neuroendocrine tumor; Risk factor; Recurrence; Treatment algorithm
- NEUROENDOCRINOLOGY, v.111, no.8, pp.794 - 804
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- Introduction: The prognostic factors of pancreatic neuroendocrine tumor (PNET) are unclear, and the treatment guidelines are insufficient. This study aimed to suggest a treatment algorithm for PNET based on risk factors for recurrence in a large cohort. Methods: Data of 918 patients who underwent curative intent surgery for PNET were collected from 14 tertiary centers. Risk factors for recurrence and survival analyses were performed. Results: The 5-year disease-free survival (DFS) rate was 86.5%. Risk factors for recurrence included margin status (R1, hazard ratio [HR] 2.438; R2, HR 3.721), 2010 WHO grade (G2, HR 3.864; G3, HR 7.352), and N category (N1, HR 2.273). A size of 2 cm was significant in the univariate analysis (HR 8.511) but not in the multivariate analysis (p = 0.407). Tumor size was not a risk factor for recurrence, but strongly reflected 2010 WHO grade and lymph node (LN) status. Tumors <= 2 cm had lower 2010 WHO grade, less LN metastasis (p < 0.001), and significantly longer 5-year DFS (77.9 vs. 98.2%, p < 0.001) than tumors >2 cm. The clinicopathologic features of tumors <1 and 1-2 cm were similar. However, the LN metastasis rate was 10.3% in 1-2-cm sized tumors and recurrence occurred in 3.0%. Tumors Discussion/Conclusion: Radical surgery is needed in suspected LN metastasis or G3 PNET or tumors >2 cm. Surveillance for <1-cm PNETs should be sufficient. Tumors sized 1-2 cm require limited surgery with LN resection, but should be converted to radical surgery in cases of doubtful margins or LN metastasis.
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- College of Medicine > Department of Medicine > Journal Articles
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