Determining prognosis in patients with pancreatic endocrine neoplasms: Can the WHO classification system be simplified? Journal Article
| Authors: | Ferrone, C. R.; Tang, L. H.; Tomlinson, J.; Gonen, M.; Hochwald, S. N.; Brennan, M. F.; Klimstra, D. S.; Allen, P. J. |
| Article Title: | Determining prognosis in patients with pancreatic endocrine neoplasms: Can the WHO classification system be simplified? |
| Abstract: | Purpose: The WHO classification for well-differentiated pancreatic endocrine neoplasms (PENs) incorporates both stage and grade. This study compares the prognostic value of a simplified staging and grading system with the WHO system in a large single-institution study. Patients and Methods: A prospective database (1982 to 2005) identified 183 patients who underwent operative treatment for PENs. Tumors were staged (< 2 cm primary, ≥ 2 cm primary, or metastases) and graded (low grade: no necrosis and < two mitoses/50 high-powered fields [HPF]; or intermediate grade: necrosis and/or ≥ two mitoses/50 HPF) with a simplified schema. Influence of stage and grade on recurrence and disease-specific survival (DSS) was determined. Prognostic strength was assessed with the concordance index (CI). Results: Median age of the 183 patients was 56 years, and 53% were women. Median follow-up time was 44 months (range, 1 to 226 months). Classification identified 28 patients (15%) with WHO 1.1 disease, 74 (41%) with 1.2 disease, and 81 (44%) with 2.0 disease. Classification by stage identified 35 patients (19%) with tumors less than 2 cm, 96 (52%) with tumors ≥ 2 cm, and 52 (29%) with nodal or distant metastases. Tumors were low grade in 102 patients (56%). Earlier stage tumors were more likely to be low grade (< 2 cm, 83%; ≥ 2 cm, 61%; metastases, 28%; P < .001). The WHO classification, tumor stage, and grade were associated with 5-year DSS (P < .001). Tumors ≥ 2 cm or metastases are stratified by grade (5-year DSS rate for low v intermediate grade: ≥ 2 cm, 97% v 80%, respectively; P < .001; metastases, 93% v 62%, respectively; P = .05). The CI was 0.72 for WHO, 0.71 for stage, 0.66 for grade, and 0.76 for stage combined with grade. Conclusion: Accurate prognostic information can be obtained by combining tumor size and metastases with simple grading information based on necrosis and mitotic rate. © 2007 by American Society of Clinical Oncology. |
| Keywords: | adult; controlled study; disease-free survival; middle aged; major clinical study; histopathology; cancer recurrence; disease classification; pancreas resection; pancreatic neoplasms; cancer staging; follow up; neoplasm staging; metastasis; neoplasm recurrence, local; pancreas tumor; liver resection; world health organization |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 25 |
| Issue: | 35 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2007-12-10 |
| Start Page: | 5609 |
| End Page: | 5615 |
| Language: | English |
| DOI: | 10.1200/jco.2007.12.9809 |
| PUBMED: | 18065733 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 28" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus" |
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