Analysis of lymph node metastasis in pancreatic neuroendocrine tumors (PNETs) based on the tumor size and hormonal production
- First Online:
- 527 Downloads
Because of the rarity and variety of pancreatic neuroendocrine tumors (PNETs), there have been few reports regarding the indication for lymph node dissection in patients with these tumors. This study aimed to evaluate the risk of lymph node metastasis of PNETs based on the tumor size and hormonal production.
Data for a total of 66 patients who had PNETs resected at our department between 1987 and 2010 were retrospectively studied. The clinicopathological features, including the disease-specific survival rate, were assessed based on the status of lymph node metastasis at the time of initial surgical resection. Then the cut-off point of tumor size to predict lymph node metastasis was estimated.
There were 12 patients (18%) with lymph node metastasis. The frequency of lymph node metastasis tended to be higher in gastrinomas than that in other tumors (43 vs. 15%; P = 0.08). The size of PNETs with lymph node metastasis was significantly larger than that of the PNETs without metastasis (P = 0.04). The postoperative survival rate in the PNET patients with lymph node metastasis was significantly lower than that in the patients without metastasis (P < 0.0001). Only 2 (8%) of 26 PNETs with a tumor size of <15 mm had lymph node metastasis, and both of these were gastrinomas. On the other hand, 10 (25%) of the remaining 40 PNETs with a tumor size of ≥15 mm had lymph node metastasis. Notably, there were no PNETs with lymph node metastasis in 22 non-gastrinomas with a tumor size of <15 mm.
Non-gastrinomas with a tumor size of ≥15 mm and all gastrinomas would be an indication for pancreatectomy with lymph node dissection.
KeywordsPancreatic neuroendocrine tumor (PNET) Lymph node metastasis Gastrinoma Non-gastrinoma
- 5.Kloppel G, Couvelard A, Perren A, Komminoth P, McNicol AM, Nilsson O, et al. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: towards a standardized approach to the diagnosis of gastroenteropancreatic neuroendocrine tumors and their prognostic stratification. Neuroendocrinology. 2009;90:162–6.PubMedCrossRefGoogle Scholar
- 7.Clark OH, Benson AB, Berlin JD, Choti MA, Doherty GM, Engstrom PF, et al. NCCN Clinical Practice Guidelines in Oncology: neuroendocrine tumors, 3rd ed. J Natl Compr Cancer Netw. 2009;7:712–47.Google Scholar
- 8.Klimstra DS, Arnold R, Capella C, Hruban RH, Kloppel G, Komminoth P, et al. Neuroendocrine neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumours of the digestive system. Lyon: IARC Press; 2010. p. 322–6.Google Scholar
- 13.Japan Pancreas Society. General Rules for the Study of Pancreatic Cancer. 6th ed. Kanehara: Tokyo; 2009.Google Scholar
- 30.Chatzipantelis P, Konstantinou P, Kaklamanos M, Apostolou G, Salla C. The role of cytomorphology and proliferative activity in predicting biologic behavior of pancreatic neuroendocrine tumors: a study by endoscopic ultrasound-guided fine-needle aspiration cytology. Cancer Cytopathol. 2009;117:211–6.CrossRefGoogle Scholar