Annals of Surgical Oncology

, Volume 24, Issue 4, pp 1127–1133

Pancreatic Duct Involvement in Well-Differentiated Neuroendocrine Tumors is an Independent Poor Prognostic Factor

  • Yoshihide Nanno
  • Ippei Matsumoto
  • Yoh Zen
  • Kyoko Otani
  • Jun Uemura
  • Hirochika Toyama
  • Sadaki Asari
  • Tadahiro Goto
  • Tetsuo Ajiki
  • Keiichi Okano
  • Yasuyuki Suzuki
  • Yoshifumi Takeyama
  • Takumi Fukumoto
  • Yonson Ku
Pancreatic Tumors

DOI: 10.1245/s10434-016-5663-8

Cite this article as:
Nanno, Y., Matsumoto, I., Zen, Y. et al. Ann Surg Oncol (2017) 24: 1127. doi:10.1245/s10434-016-5663-8
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Abstract

Background

The biological behavior of well-differentiated neuroendocrine tumors of the pancreas (PNETs) is difficult to predict. This study was designed to determine whether involvement of the main pancreatic duct (MPD) serves as a poor prognostic factor for PNETs.

Methods

The involvement of the MPD in PNETs was defined as ductal stenosis inside the tumor mass associated with distal MPDs more than twofold larger in diameter than the proximal ducts. We examined the correlation between MPD involvement and other clinicopathological parameters, including nodal metastasis and recurrence-free survival, in 101 patients treated consecutively at three referral centers in Japan. All patients underwent surgical resection.

Results

MPD involvement was observed in 13 of the 101 cases (13%) and was associated with multiple unfavorable clinicopathological features (e.g., larger tumor size, higher histological grade, more frequent nodal metastasis, and higher recurrence rates). Patients with MPD involvement also showed significantly worse recurrence-free survival than did those without ductal involvement (P < 0.001), with a 5 years recurrence-free rate of 41%. On multivariate analysis, MPD involvement was significantly associated with nodal metastasis [odds ratio (OR) 16; 95% confidence interval (CI) 3.8–89; P < 0.001] and recurrence (OR 8.0; 95% CI 1.7–46; P = 0.009). The radiology–pathology correlation revealed that stenosis of the MPD was due to periductal and/or intraductal tumor invasion. Cases with MPD involvement had microscopic venous invasion (P = 0.010) and perineural infiltration (P = 0.002) more frequently than did those with no ductal infiltration.

Conclusions

MPD involvement in PNETs may serve as an imaging sign indicating an aggressive clinical course.

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Yoshihide Nanno
    • 1
  • Ippei Matsumoto
    • 2
  • Yoh Zen
    • 3
  • Kyoko Otani
    • 3
  • Jun Uemura
    • 4
  • Hirochika Toyama
    • 1
  • Sadaki Asari
    • 1
  • Tadahiro Goto
    • 1
  • Tetsuo Ajiki
    • 1
  • Keiichi Okano
    • 4
  • Yasuyuki Suzuki
    • 4
  • Yoshifumi Takeyama
    • 2
  • Takumi Fukumoto
    • 1
  • Yonson Ku
    • 1
  1. 1.Division of Hepato-Biliary-Pancreatic Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan
  2. 2.Division of Hepato-Biliary-Pancreatic Surgery, Department of SurgeryKindai University Faculty of MedicineOsaka-SayamaJapan
  3. 3.Department of Diagnostic PathologyKobe University Graduate School of MedicineKobeJapan
  4. 4.Department of Gastroenterological SurgeryKagawa University Faculty of MedicineTakamatsuJapan