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Outcomes of Lymph Node Dissection for Non-metastatic Pancreatic Neuroendocrine Tumors: A Propensity Score-Weighted Analysis of the National Cancer Database

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although the National Comprehensive Cancer Network (NCCN) guidelines recommend use of lymph node dissection (LND) in patients with pancreatic neuroendocrine tumors (pNETs) > 2 cm, there is limited evidence to support the association between use of LND and overall survival (OS).

Methods

Patients with resected pNETs were identified in the National Cancer Database (2004–2014). The inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan–Meier curves and Cox proportional hazards models were used to compare OS of patients in different treatment groups.

Results

A total of 2664 patients diagnosed met the study entry criteria. Of these, 2132 patients (80.6%) received LND, with a median of nine nodes removed. Positive nodes were identified in 28.0% of patients who underwent LND. IPTW-adjusted Kaplan–Meier analysis showed that median OS was similar between the LND and LND-omitted groups (152.8 vs. 147.3 months; p = 0.61). In IPTW-adjusted Cox proportional hazards regression analysis, LND was not associated with an OS benefit (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.94–1.42; p = 0.18). The results were consistent across subgroups stratified by clinical T and N stages. Among patients with lymph node metastasis, the number of removed nodes (NRN) above the median was not associated with an improved OS (HR 0.82, 95% CI 0.60–1.13; p = 0.22).

Conclusions

LND had no additional therapeutic benefit among patients undergoing resection for pNETs. The present findings should be considered when managing patients with resectable pNETs.

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Acknowledgment

This work was supported by the National Natural Science Foundation of China (81672461); Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (CIFMS; Grant No. 2017-12M-4-002); and the Capital Health Research and Development of Special (2018-1-4021). Sheng Luo’s research was partly supported by Grant R01NS091307 from the National Institute of Neurological Disorders and Stroke (NINDS) and Grant R56AG062302 from the National Institute on Aging (NIA).

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Author notes

  1. Rui Mao, Hong Zhao and Kan Li have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Rui Mao MD, Hong Zhao MD & Jian-Qiang Cai MD

  2. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA

    Rui Mao MD

  3. Merck Research Laboratory, Merck & Co, North Wales, PA, USA

    Kan Li PhD

  4. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

    Sheng Luo PhD

  5. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Megan Turner MD & Dan Blazer III MD

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  1. Rui Mao MD
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Correspondence to Dan Blazer III MD.

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Rui Mao, Hong Zhao, Kan Li, Sheng Luo, Megan Turner, Jian-Qiang Cai, and Dan Blazer III report no conflicts of interest.

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Mao, R., Zhao, H., Li, K. et al. Outcomes of Lymph Node Dissection for Non-metastatic Pancreatic Neuroendocrine Tumors: A Propensity Score-Weighted Analysis of the National Cancer Database. Ann Surg Oncol 26, 2722–2729 (2019). https://doi.org/10.1245/s10434-019-07506-5

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