Disease-free survival after pancreatectomy for pancreatic neuroendocrine tumors: A 17-year single-center experience of 223 patients Journal Article


Authors: Mukkala, A. N.; Ray, S.; Bevacqua, D.; McGilvray, I.; Sapisochin, G.; Moulton, C. A.; Gallinger, S.; Cleary, S. P.; Shwaartz, C.; Wei, A. C.; Reichman, T. W.
Article Title: Disease-free survival after pancreatectomy for pancreatic neuroendocrine tumors: A 17-year single-center experience of 223 patients
Abstract: Background: Metastasis or recurrence of pancreatic neuroendocrine tumors (pNETs) after pancreatectomy is an important source of postsurgical morbidity. This study aimed to define disease-free survival (DFS) in this population. Methods: Patients who underwent pancreatectomy for pNETs between January 2005 and January 2022 were included. Clinicopathologic and survival data were collected, and the primary endpoint was DFS. Kaplan-Meier survival analysis and Cox proportional hazards regression modeling were performed. Results: Of the 223 patients, 144 (65%) distal/subtotal/partial pancreatectomies, 71 (32%) pancreaticoduodenectomies, 6 (3%) total pancreatectomies, and 2 (1%) enucleations were performed. Of the 223 patients, 45 (20%) experienced disease recurrence or metastasis after index pancreatectomy during the 17 years of the study. Nonfunctional pNETs (162 [73%]) were more common than hormonally functional subtypes. The 2- and 5-year DFSs were 82% and 76%, respectively. Kaplan-Meier analysis demonstrated that N1 node positive disease, size of ≥ 4 cm, lymphovascular invasion, perineural invasion, Ki-67 of ≥ 20%, and nonfunctional pNETs are significantly associated with a lower DFS (P < .05). Univariate Cox analysis identified the following predictors to be significantly associated with poorer DFS: larger tumor size (hazard ratio [HR], 1.16; 95% CI, 1.04–1.28), Ki-67 index of ≥ 20% (HR, 4.93; 95% CI, 2.00–11.44), perineural invasion (HR, 3.23; 95% CI, 1.40–7.89), open surgery (HR, 3.34; 95% CI, 1.03–1.33), node-positive disease (HR, 5.27; 95% CI, 2.28–13.26), and increased body mass index (HR, 1.10; 95% CI, 1.03–1.17) (P < .05). Conclusion: Of note, 1 in 5 patients who underwent resection developed recurrence or metastasis after pancreatectomy. Prognostic predictors of DFS in pNETs could help optimize treatment and enhance follow-up protocols to improve quality and reduce morbidity. © 2024
Keywords: disease-free survival; pancreatectomy; pancreatic neuroendocrine tumor; prognosis
Journal Title: Journal of Gastrointestinal Surgery
Volume: 28
Issue: 9
ISSN: 1091-255X
Publisher: Springer  
Date Published: 2024-09-01
Start Page: 1485
End Page: 1492
Language: English
DOI: 10.1016/j.gassur.2024.06.015
PROVIDER: scopus
PUBMED: 38906319
DOI/URL:
Notes: Article -- Source: Scopus
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  1. Alice Chia-Chi Wei
    204 Wei