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Predictive value of the Ki67 index for lymph node metastasis of small non-functioning pancreatic neuroendocrine neoplasms

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Abstract

Background

We evaluated the clinicopathological factors associated with lymph node metastasis in patients with non-functioning pancreatic neuroendocrine neoplasms (PanNENs), focusing on the risk factors and range of lymph node metastasis for tumors ≤ 2 cm in diameter.

Methods

The subjects of this study were patients with PanNENs consecutively diagnosed at our hospital between January, 2000 and June, 2018. We analyzed 69 patients who underwent R0 resection of a non-functioning sporadic PanNEN with no distant metastasis, as well as 43 patients with tumors ≤ 20 mm in radiological diameter.

Results

Nineteen patients (27.5%), including 7 (16.3%) with a small PanNEN, had lymph node metastasis. A large radiological diameter, a high Ki67 index, and cyst formation correlated significantly with positive lymph node metastasis. In patients with tumors ≤ 20 mm in diameter, a high Ki67 index correlated significantly with lymph node metastasis. When we set the cut-off Ki67 index as 3.3%, 2 of 43 patients had lymph node metastasis. Tumors in the uncinate process readily metastasized to the region around the superior mesenteric artery.

Conclusions

These findings suggest that a high Ki67 index indicates a risk of lymph node metastasis for tumors ≤ 20 mm in diameter and that lymphadenectomy should be performed in the region spatially adjacent to the primary tumor.

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Funding

This work was supported by JSPS KAKENHI Grant number JP18K08677.

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Authors and Affiliations

  1. Department of Surgery, Kyoto University, 54 Shogoin, Kawaracho, Sakyo, Kyoto, 606-8507, Japan

    Toshihiko Masui, Asahi Sato, Kenzo Nakano, Yuichiro Uchida, Akitada Yogo, Takayuki Anazawa, Kazuyuki Nagai, Yoshiya Kawaguchi, Kyoichi Takaori & Shinji Uemoto

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  1. Toshihiko Masui
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  2. Asahi Sato
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  3. Kenzo Nakano
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  4. Yuichiro Uchida
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Correspondence to Toshihiko Masui.

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Masui, T., Sato, A., Nakano, K. et al. Predictive value of the Ki67 index for lymph node metastasis of small non-functioning pancreatic neuroendocrine neoplasms. Surg Today 49, 593–600 (2019). https://doi.org/10.1007/s00595-019-01779-9

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