Evaluation of Outcomes Following Surgery for Locally Advanced Pancreatic Neuroendocrine Tumors.
Evaluation of Outcomes Following Surgery for Locally Advanced Pancreatic Neuroendocrine Tumors.
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DOI：
10.1001/jamanetworkopen.2020.24318
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发表时间：
2020-11-02
影响因子：
13.8
通讯作者：
Jensen RT
中科院分区：
文献类型：
--
作者：
Titan AL;Norton JA;Fisher AT;Foster DS;Harris EJ;Worhunsky DJ;Worth PJ;Dua MM;Visser BC;Poultsides GA;Longaker MT;Jensen RT
What are the outcomes of patients who undergo aggressive resection of locally advanced pancreatic neuroendocrine tumors (PNETs)? In this case series, 99 patients with locally advanced (T3/T4) PNETs and no known distant metastatic disease who underwent resection had a recurrence rate of 35%, but their quality of life remained high, and the overall 5-year survival was 91%. These findings suggest that locally advanced PNETs warrant aggressive surgical resection, including local organs and blood vessels, if necessitated by tumor invasion. This case series examines data from 2003 to 2018 regarding patients who underwent aggressive resection operative treatment for locally advanced pancreatic neuroendocrine tumors and their outcomes in terms of disease recurrence, quality of life, and overall 5-year survival. Although outcome of surgical resection of liver metastases from pancreatic neuroendocrine tumors (PNETs) has been extensively studied, little is known about surgery for locally advanced PNETs; it was listed recently by the European neuroendocrine tumor society as a major unmet need. To evaluate the outcome of patients who underwent surgery for locally aggressive PNETs. This retrospective single-center case series reviewed consecutive patients who underwent resection of T3/T4 PNETs at a single academic institution. Data collection occurred from 2003 to 2018. Data analysis was performed in August 2019. Disease-free survival (primary outcome) and overall mortality (secondary outcome) were assessed with Kaplan-Meier analysis. Recurrence risk (secondary outcome, defined as identification of tumor recurrence on imaging) was assessed with Cox proportional hazard models adjusting for covariates. In this case series, 99 patients with locally advanced nondistant metastatic PNET (56 men [57%]) with a mean (SEM) age of 57.0 (1.4) years and a mean (SEM) follow-up of 5.3 (0.1) years underwent surgically aggressive resections. Of those, 4 patients (4%) underwent preoperative neoadjuvant treatment (including peptide receptor radionuclide therapy and chemotherapy); 18 patients (18%) underwent pancreaticoduodenectomy, 68 patients (69%) had distal or subtotal pancreatic resection, 10 patients (10%) had total resection, and 3 patients (3%) had other pancreatic procedures. Additional organ resection was required in 86 patients (87%): spleen (71 patients [71%]), major blood vessel (17 patients [17%]), bowel (2 patients [2%]), stomach (4 patients [4%]), and kidney (2 patients [2%]). Five-year disease-free survival was 61% (61 patients) and 5-year overall survival was 91% (91 patients). Of those living, 75 patients (76%) had an Eastern Cooperative Oncology Group score of less than or equal to 1 at last followup. Lymph node involvement (HR, 7.66; 95% CI, 2.78-21.12; P < .001), additional organ resected (HR, 6.15; 95% CI, 1.61-23.55; P = .008), and male sex (HR, 3.77; 95% CI, 1.68-8.97; P = .003) were associated with increased risk of recurrence. Functional tumors had a lower risk of recurrence (HR, 0.23; CI, 0.06-0.89; P = .03). Required resection of blood vessels was not associated with a significant increase recurrence risk. In this case series, positive lymph node involvement and resection of organs with tumor involvement were associated with an increased recurrence risk. These subgroups may require adjuvant systemic treatment. These findings suggest that patients with locally advanced PNETs who undergo surgical resection have excellent disease-free and overall survival.
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影响因子：
3.2
作者：
Nigri G;Petrucciani N;Debs T;Mangogna LM;Crovetto A;Moschetta G;Persechino R;Aurello P;Ramacciato G
通讯作者：
Ramacciato G
影响因子：
2.9
作者：
Dong, Ding-Hui;Zhang, Xu-Feng;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
影响因子：
3.7
作者：
Castleberry, Anthony W.;White, Rebekah R.;Scarborough, John E.
通讯作者：
Scarborough, John E.
影响因子：
--
作者：
Norton, Jeffrey A.;Harris, Edmund J.;Jensen, Robert T.
通讯作者：
Jensen, Robert T.
影响因子：
4.1
作者：
Jia, Zhongzhi;Paz-Fumagalli, Ricardo;Wang, Weiping
通讯作者：
Wang, Weiping