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"
Altmetric Score
MSK Authors
  1. Cristina Ferrone
    32 Ferrone
  2. Murray F Brennan
    756 Brennan
  3. Mithat Gonen
    701 Gonen
  4. David S Klimstra
    843 Klimstra
  5. Peter Allen
    436 Allen
  6. Laura Hong Tang
    320 Tang