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Clinical Prognosticators of Metastatic Potential in Patients with Small Pancreatic Neuroendocrine Tumors

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

While observation of T1(≤2cm) nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) is an accepted practice, an ill-defined subgroup of patients with T1 tumors develops metastases. This study aimed to identify those patients via clinical factors.

Methods

Patients from the Surveillance, Epidemiology, and End Results (SEER) registry who were diagnosed with NF-PanNET with size ≤2cm between 1998 and 2014 and who underwent primary tumor resection were identified. Binary logistic regression analyses were performed to evaluate factors associated with pathological nodal and systemic metastatic disease.

Results

A total of 612 patients with T1 NF-PanNETs were identified. Of those, 72 (11.7%) developed nodal metastasis and 35 (5.7%) distant metastasis (M1). In the multivariable analysis, tumor location in the pancreatic body (OR 1.903, p=0.03) (OR 1.407, p=0.038) or tail (OR 1.258, p=0.04) (OR 1.612, p=0.021); tumor grade III–IV (OR 2.042, p=0.022) (OR 5.379, p≤0.001); and younger age (OR 0.963, p=0.01) (OR 0.919, p=0.009) were associated with nodal metastases and the presence of M1 disease, respectively.

Conclusion

While the low metastatic potential of ≤2cm NF-PanNET implies watchful waiting to be an appropriate strategy for most patients, the increased risk of metastatic disease in younger patients with high grade (III–IV) body/tail tumors suggests individualized risk stratification to be optimal.

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Authors and Affiliations

  1. Department of Surgery, St. Elizabeth’s Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, Boston, MA, USA

    Eduardo A. Vega, Omid Salehi & Claudius Conrad

  2. Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA

    Onur C. Kutlu

  3. Department of Medical Oncology & Hematology, St. Elizabeth’s Medical Center, Boston, MA, USA

    Sylvia V. Alarcon & Olga Kozyreva

  4. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Sylvia V. Alarcon, Olga Kozyreva & Jennifer A. Chan

  5. Department of Medicine, St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA

    Vera Kazakova

Authors
  1. Eduardo A. Vega
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  2. Onur C. Kutlu
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  3. Sylvia V. Alarcon
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  4. Omid Salehi
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  5. Vera Kazakova
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  8. Claudius Conrad
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Contributions

Substantial contributions to:

- The conception or design of the work: all authors.

- The acquisition, analysis, or interpretation of data for the work: EAV, OCK, OS, SVA, and CC.

- Drafting the work or revising it critically for important intellectual content: all authors.

- Final approval of the version to be published: all authors.

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

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Correspondence to Claudius Conrad.

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Supplementary Information

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ESM 2

Supplementary Figure 1. CONSORT diagram of the study (PNG 6596 kb)

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ESM 3

Supplementary Figure 2. Kaplan Meir Curve stratified by M status of disease specific survival (A) and overall survival (B) (PNG 6596 kb)

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Vega, E.A., Kutlu, O.C., Alarcon, S.V. et al. Clinical Prognosticators of Metastatic Potential in Patients with Small Pancreatic Neuroendocrine Tumors. J Gastrointest Surg 25, 2593–2599 (2021). https://doi.org/10.1007/s11605-021-04946-x

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  • DOI: https://doi.org/10.1007/s11605-021-04946-x

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