scholarly journals Surgical resection of primary tumor is associated with prolonged survival in low-grade pancreatic neuroendocrine tumors

2020 ◽  
pp. 101432
Author(s):  
Yaoyao Sun ◽  
Yueying Wang ◽  
Rixin Li ◽  
Guojun Kang ◽  
Mingyuan Zhang ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Primary Tumor ◽  
Prolonged Survival ◽  
Low Grade ◽  
Pancreatic Neuroendocrine Tumors

scholarly journals Resection of primary tumor site is associated with prolonged survival in metastatic nonfunctioning pancreatic neuroendocrine tumors

Surgery ◽  
2016 ◽  
Vol 159 (1) ◽  
pp. 311-319 ◽  
Author(s):  
Xavier M. Keutgen ◽  
Naris Nilubol ◽  
Joanne Glanville ◽  
Samira M. Sadowski ◽  
David J. Liewehr ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Primary Tumor ◽  
Prolonged Survival ◽  
Tumor Site ◽  
Pancreatic Neuroendocrine Tumors ◽  
Primary Tumor Site

Indications for Surgical Resection in Low-Grade Pancreatic Neuroendocrine Tumors

2016 ◽  
Vol 82 (8) ◽  
pp. 737-742 ◽  
Author(s):  
Timothy L. Fitzgerald ◽  
Catalina Mosquera ◽  
Haily S. Vora ◽  
Nasreen A. Vohra ◽  
Emmanuel E. Zervos
Keyword(s):  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Tumor Size ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Low Grade ◽  
Pancreatic Neuroendocrine Tumors ◽  
Free Survival ◽  
Increased Risk ◽  
Disease Free

The role of surgical resection in low-grade pancreatic neuroendocrine tumors (P-NET) is unclear. The patients diagnosed with low-grade P-NET from 1988 to 2012 were identified in SEER. Five hundred and sixty-one patients met the inclusion criteria. A majority were white (82.9%), and node negative (69.9%). Univariate analysis revealed that tumor size (<2 cm 8.3%, 2–4 cm 38.5%, and >4 cm 40.3%; P < 0.0001) and surgery (30.9% vs 25.3%; P = 0.0014) were associated with the risk of lymph node metastases (LNM). In contrast, age ( P = 0.8360), gender ( P = 0.4903), and race ( P = 0.4235) were not. Five-year disease-free survival was associated with size (<2 cm 89.4%, 2–4 cm 80.0%, and >4 cm 74.5%; P = 0.0089), LNM (72.4% vs 82.9%; P = 0.0025), and surgery (84.3% vs 47.5%; P < 0.0001). Cox regression model showed that the association with LNM ( P = 0.0025) and surgery ( P < 0.0001) was significant. Surgery was associated with an improved disease-free survival for tumors >2 cm (2–4 cm, 84.4% vs 26.0% at five years; P = 0.0003, and >4 cm, 80.5% vs 49.5% at five years; P < 0.0001) but not for those with tumor size <2 cm ( P = 0.4525). In conclusions, low-grade P-NETs in patients with tumor size >2 cm showed an increased risk of LNM and improved survival with resection.

scholarly journals Aggressive surgical resection for pancreatic neuroendocrine tumors

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e395-e396
Author(s):  
S. Zaheer ◽  
J. Datta ◽  
C. Vollmer ◽  
M. Lee ◽  
J. Drebin ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Pancreatic Neuroendocrine Tumors

Resected pancreatic neuroendocrine tumors: Patterns of failure and disease-related outcomes with or without radiotherapy.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 325-325
Author(s):  
T. M. Zagar ◽  
R. R. White ◽  
C. G. Willett ◽  
P. Papavassiliou ◽  
D. S. Tyler ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Adjuvant Radiotherapy ◽  
Pancreatic Head ◽  
Pancreatic Neuroendocrine Tumors ◽  
High Power Field ◽  
Patterns Of Failure ◽  
Curative Intent ◽  
Pathologic Features

325 Background: Pancreatic neuroendocrine tumors (NET) are rare with improved prognosis compared to adenocarcinomas. Surgical resection remains the standard of care although many patients present with unresectable/metastatic disease. While many resected patients will fail distantly, little is known regarding the use of adjuvant radiotherapy. To define this and establish specific patterns of failure, an analysis of resected patients from a single institution was performed. Methods: From 1994 to 2009, 33 patients with NET of the pancreatic head underwent resection with curative intent at Duke University. Sixteen patients were treated with surgical resection alone, and an additional 17 underwent resection with adjuvant (n=10) or neoadjuvant (n=7) radiation therapy, usually with concurrent fluoropyrimidine-based chemotherapy (CMT). Median radiation dose was 50.4 Gy and median follow-up 28 months. Results: Patients receiving radiation therapy were more likely to have involved nodes (47% vs 19%, p=0.09), more mitoses per high power field (p=0.10) and involved margins (47% vs 31%, p=0.20) compared to surgery alone patients. Median survival for the whole cohort was 52 months. Two-year survival was 68% for the CMT group and 93% for the surgery alone group (p=0.03). Two-year local control was 85% for the CMT and 90% for the surgery group (p=0.49). Two-year metastasis-free survival was 45% and 69% for the CMT and surgery patients, respectively (p=0.02). Conclusions: Patients receiving CMT were more likely to have adverse pathologic features compared to surgery-alone patients. Survival outcomes were high in both groups, although less so in the CMT group. Distant metastasis development dominated patterns of failure. Local failure following resection of NETs is uncommon, and the role of adjuvant radiotherapy in this setting remains unclear. No significant financial relationships to disclose.

Prognostic impact of baseline CEA level and surgery of primary tumor among patients with stage IV denovo colon cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 503-503
Author(s):  
S. S. Dawood ◽  
A. M. Gonzalez-Angulo ◽  
C. Eng
Keyword(s):  
Colorectal Cancer ◽  
Surgical Resection ◽  
Primary Tumor ◽  
Large Population ◽  
Stage Iv ◽  
Low Grade ◽  
Prognostic Impact ◽  
Tumor Surgery ◽  
Risk Of Death ◽  
Increased Risk

503 Background: Surgical resection of primary tumor among pts with stageIV denovo colorectal cancer is controversial. Prognostic role of baseline CEA level in the same cohort has yet to be defined. The objective of this study was to determine the prognostic value of CEA and surgical resection of primary tumor among pts with stage IV denovo colorectal cancer in the era of biologic therapy and to determine subgroups with improved survival outcome. Methods: The Surveillance, Epidemiology and End Results Registry was searched to identify patients with stage IV denovo colorectal cancer diagnosed between 2004-2007. Colorectal cancer specific survival (CCS) was estimated using the Kaplan-Meier product limit method. Cox models were fitted to assess the multivariable relationship of various pt and tumor characteristics and CCS. Results: 19,437 pts were identified with stage IV denovo colorectal cancer. Median CCS was 15M. Median CCS among pts with primary tumor removed was 20M vs 8M (primary intact; p<0.001). Median CCS among pts who had elevated vs. non elevated CEA was 14M vs 23M (p<0.0001). Among pts who had primary tumor surgery median CCS among pts who had elevated vs. non elevated CEA was 19M vs 29M (p<0.0001). Among pts who had primary tumor and distant disease surgically removed, the median CCS among pts who had elevated vs. non elevated CEA was 24M vs 35M (p<0.0001). By multivariable analysis, pts with elevated CEA had a 51% increased risk of death from colorectal cancer compared to those with a non elevated CEA level (HR=1.51, 95%CI 1.40-1.65, p<0.0001). Pts who underwent primary tumor surgery had a 33% decreased risk of death from colorectal cancer compared to those who did not (HR=0.67, 95%CI 0.58-0.78, p<0.0001). Other factors significantly associated with a decreased risk of death from colorectal cancer included low grade disease, non visceral metastases, surgical resection of metastases, younger age and white race. Conclusions: In this large population study, elevated baseline CEA level and surgical resection of the primary tumor had a significant impact on survival outcomes. The best prognostic group were those pts with normal baseline CEA level who proceeded to surgical resection for their primary tumor. No significant financial relationships to disclose.

Pancreatic neuroendocrine tumors: Single institution review over 10 years.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15183-e15183
Author(s):  
Aakanksha Asija ◽  
Stacey Milan ◽  
Anthony Prestipino ◽  
Charles Yeo ◽  
Madhavan V. Pillai
Keyword(s):  
Surgical Resection ◽  
Median Survival ◽  
Neuroendocrine Tumors ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Tnm Staging ◽  
The Body ◽  
Stage I ◽  
University Hospital ◽  
Pancreatic Neuroendocrine Tumors

e15183 Background: Pancreatic neuroendocrine tumors(pNET) are rare tumors accounting for less than 5% of pancreatic cancer. They are functionally and biologically heterogeneous and have not been studied in great detail until recently. Methods: We conducted a retrospective review of 79 consecutive patients with pNET diagnosed and treated at Thomas Jefferson University Hospital between the years of 2000 and 2010. Results: Of the 79 patients whose records were reviewed, 32 were male and 47 were female. Median age at diagnosis was 61 years. Two cases were associated with MEN1 syndrome. Primary tumor arose in the head, body and tail of the pancreas in 15, 10 and 26 patients, resp. In 6 patients, the tumor was multifocal. The neuroendocrine tumor was accompanied by pancreatic adenocarcinoma in 1 patient and intraductal papillary mucinous neoplasm in 3. In 10 patients, distant metastasis was detected, involving liver only. Tumor was functional in 9 patients: 5 insulinoma, 2 gastrinoma,1 glucagonoma and 1 VIPoma. As per TNM staging, 28, 22 and 10 patients were Stage I, II and III, and IV at diagnosis. Treatment by surgical resection was undertaken in 54 patients. In 21 patients, the tumor was discovered incidentally; 21 patients presented with abdominal pain. Other symptoms were irregular bowel movements, weight loss and jaundice. 51 of the 79 (64.5%) patients were alive at last follow up. On univariate analysis, median survival for females was 137 months vs 114 months for male. Median survival for patients with functional tumors was similar to those with nonfunctioning tumors (118 and 115 months, resp). Median survival for patients with Stage I, II, and III and Stage IV patients were 234,112 and 40 months resp. Median survival for patients who underwent surgical resection was 130 months vs those who did not (30 months). Conclusions: Majority of pNET were located in the body and tail of pancreas; an area requiring thorough scrutiny with special imaging studies for diagnosis. Only a minority of patients presented with liver metastasis(12%) and a smaller number showed hormonal activity (11%). Prognosis improved markedly in patients who underwent surgical resection. Therefore, whenever appropriate, surgical resection should be the treatment of choice in patients with pNET.

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