Advertisement

Journal of Gastrointestinal Surgery

, Volume 11, Issue 11, pp 1460–1469 | Cite as

Clinicopathologic Features and Treatment Trends of Pancreatic Neuroendocrine Tumors: Analysis of 9,821 Patients

  • Karl Y. Bilimoria
  • James S. Tomlinson
  • Ryan P. Merkow
  • Andrew K. Stewart
  • Clifford Y. Ko
  • Mark S. Talamonti
  • David J. BentremEmail author
Article

Abstract

The natural history of pancreatic neuroendocrine tumors (PNET) remains poorly defined. Our objectives were to examine the clinicopathologic features of PNETs, to assess treatment trends over time, and to identify factors associated with undergoing resection. From the National Cancer Data Base (1985–2004), 9,821 patients were identified with PNETs. Clinicopathologic features and treatment trends were examined. Multivariable logistic regression was used to assess factors associated with undergoing resection. Of 9,821 patients with PNETs, 85% were nonfunctional, 7.1% were functional, and 7.9% were carcinoid tumors. Of the 3,851 (39.0%) patients who underwent pancreatectomy, 449 (11.7%) received adjuvant chemotherapy, and 254 (6.6%) received adjuvant radiation. From 1985 to 2004, utilization of pancreatectomy increased from 39.4 to 44.3% (P < 0.0001). Patients were less likely to undergo resection if they were >55 years old, had tumors in the head of the pancreas, tumors ≥4 cm, or had distant metastases (P < 0.0001). Patients treated at NCCN/NCI, academic, or high-volume hospitals were more likely to undergo resection. There are disparities in the utilization of pancreatectomy for PNETs. As PNETs have a better prognosis than adenocarcinoma, concerns regarding the morbidity and mortality of pancreatic surgery and neoplasms should not preclude resection.

Keywords

Pancreatic neuroendocrine tumors Surgery Pancreatectomy National Cancer Data Base 

Notes

Acknowledgements

KYB is supported by the American College of Surgeons, Clinical Scholars in Residence program and a research grant from the Department of Surgery, Feinberg School of Medicine, Northwestern University. This study was presented in part at the 48th Annual Meeting of the Society for Surgery of the Alimentary Tract (SSAT) meeting at Digestive Disease Week 2007 in Washington, DC on May 23, 2007.

References

  1. 1.
    Mullan MH, Gauger PG, Thompson NW. Endocrine tumours of the pancreas: review and recent advances. ANZ J Surg 2001;71(8):475–482.PubMedCrossRefGoogle Scholar
  2. 2.
    Fesinmeyer MD, Austin MA, Li CI, et al. Differences in survival by histologic type of pancreatic cancer. Cancer Epidemiol Biomarkers Prev 2005;14(7):1766–1773.PubMedCrossRefGoogle Scholar
  3. 3.
    Fitzgerald T, Hickner Z, Schmitz M, et al. Increasing incidence of nonfunctional neuroendocrine tumors of the pancreas. American Society of Clinical Oncology Gastrointestinal Cancers Symposium. Orlando, FL., 2007.Google Scholar
  4. 4.
    Capella C, Heitz PU, Hofler H, et al. Revised classification of neuroendocrine tumours of the lung, pancreas and gut. Virchows Arch 1995;425(6):547–560.PubMedCrossRefGoogle Scholar
  5. 5.
    Fernandez-del Castillo C, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg 1995;130(3):295–299 (discussion 299–300).PubMedGoogle Scholar
  6. 6.
    Richter A, Niedergethmann M, Sturm JW, et al. Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg 2003;27(3):324–329.PubMedCrossRefGoogle Scholar
  7. 7.
    Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg 2004;139(7):718–725 (discussion 725–727).PubMedCrossRefGoogle Scholar
  8. 8.
    Sohn TA, Yeo CJ, Cameron JL, et al. Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 2000;4(6):567–579.PubMedCrossRefGoogle Scholar
  9. 9.
    Whipple AO. An evaluation of radical surgery for carcinoma of the pancreas and ampullary region. Ann Intern Med 1949;31(4):624–627.PubMedGoogle Scholar
  10. 10.
    Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244(1):10–15.PubMedCrossRefGoogle Scholar
  11. 11.
    Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995;222(5):638–645.PubMedCrossRefGoogle Scholar
  12. 12.
    Jarufe NP, Coldham C, Orug T, et al. Neuroendocrine tumours of the pancreas: predictors of survival after surgical treatment. Dig Surg 2005;22(3):157–162.PubMedCrossRefGoogle Scholar
  13. 13.
    Norton JA. Surgery for primary pancreatic neuroendocrine tumors. J Gastrointest Surg 2006;10(3):327–331.PubMedCrossRefGoogle Scholar
  14. 14.
    Winchester DP, Stewart AK, Bura C, Jones RS. The National Cancer Data Base: a clinical surveillance and quality improvement tool. J Surg Oncol 2004;85(1):1–3.PubMedCrossRefGoogle Scholar
  15. 15.
    Guo KJ, Liao HH, Tian YL, et al. Surgical treatment of nonfunctioning islet cell tumor: report of 41 cases. Hepatobiliary Pancreat Dis Int 2004;3(3):469–472.PubMedGoogle Scholar
  16. 16.
    Commission on Cancer. Standards of the Commission on Cancer Volume II: Registry operations and data standards. Chicago: American College of Surgeons, 1998.Google Scholar
  17. 17.
    Facility Oncology Registry Data Standards. Chicago: American College of Surgeons, Commission on Cancer, 2004.Google Scholar
  18. 18.
    Commission on Cancer: Approvals Categories. http://www.facs.org/cancer/coc/categories.html, 2006.
  19. 19.
    Hosmer J, Lemeshow S. Applied Logistic Regression. New York: Wiley, 1999.Google Scholar
  20. 20.
    United States Census Bureau. Census 2000. http://www.census.gov/main/www/cen2000.html. Accessed January 21, 2007.
  21. 21.
    Hochwald SN, Zee S, Conlon KC, et al. Prognostic factors in pancreatic endocrine neoplasms: an analysis of 136 cases with a proposal for low-grade and intermediate-grade groups. J Clin Oncol 2002;20(11):2633–2642.PubMedCrossRefGoogle Scholar
  22. 22.
    Madeira I, Terris B, Voss M, et al. Prognostic factors in patients with endocrine tumours of the duodenopancreatic area. Gut 1998;43(3):422–427.PubMedCrossRefGoogle Scholar
  23. 23.
    Panzuto F, Nasoni S, Falconi M, et al. Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization. Endocr Relat Cancer 2005;12(4):1083–1092.PubMedCrossRefGoogle Scholar
  24. 24.
    Schurr PG, Strate T, Rese K, et al. Aggressive surgery improves long-term survival in neuroendocrine pancreatic tumors: an institutional experience. Ann Surg 2007;245(2):273–281.PubMedCrossRefGoogle Scholar
  25. 25.
    National Comprehensive Cancer Network (NCCN): Neuroendocrine Tumors. http://www.nccn.org, 2007.
  26. 26.
    Touzios JG, Kiely JM, Pitt SC, et al. Neuroendocrine hepatic metastases: does aggressive management improve survival? Ann Surg 2005;241(5):776–783 (discussion 783–785).PubMedCrossRefGoogle Scholar
  27. 27.
    Chamberlain RS, Canes D, Brown KT, et al. Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 2000;190(4):432–445.PubMedCrossRefGoogle Scholar
  28. 28.
    Bilimoria K, Bentrem D, Ko C, et al. National failure to operate on early-stage pancreatic cancer. Ann Surg 2007 (On line).Google Scholar
  29. 29.
    O’Connell JB, Maggard MA, Ko CY. Cancer-directed surgery for localized disease: decreased use in the elderly. Ann Surg Oncol 2004;11(11):962–969.PubMedCrossRefGoogle Scholar
  30. 30.
    Makary MA, Winter JM, Cameron JL, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 2006;10(3):347–356.PubMedCrossRefGoogle Scholar
  31. 31.
    Bilimoria K, Bentrem D, Ko C, et al. National failure to operate on early-stage pancreatic cancer in the United States. 2007 (in press).Google Scholar
  32. 32.
    Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998;280(20):1747–1751.PubMedCrossRefGoogle Scholar
  33. 33.
    Cameron JL, Pitt HA, Yeo CJ, et al. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993;217(5):430–435 (discussion 435–438).PubMedCrossRefGoogle Scholar
  34. 34.
    Chung JC, Choi DW, Jo SH, et al. Malignant nonfunctioning endocrine tumors of the pancreas: Predictive factors for survival after surgical Treatment. World J Surg 2007.Google Scholar
  35. 35.
    Liang H, Wang P, Wang XN, et al. Management of nonfunctioning islet cell tumors. World J Gastroenterol 2004;10(12):1806–1809.PubMedGoogle Scholar
  36. 36.
    Solorzano CC, Lee JE, Pisters PW, et al. Nonfunctioning islet cell carcinoma of the pancreas: survival results in a contemporary series of 163 patients. Surgery 2001;130(6):1078–1085.PubMedCrossRefGoogle Scholar
  37. 37.
    Tomassetti P, Campana D, Piscitelli L, et al. Endocrine pancreatic tumors: factors correlated with survival. Ann Oncol 2005;16(11):1806–1810.PubMedCrossRefGoogle Scholar
  38. 38.
    Venkatesh S, Ordonez NG, Ajani J, et al. Islet cell carcinoma of the pancreas. A study of 98 patients. Cancer 1990;65(2):354–357.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Karl Y. Bilimoria
    • 1
    • 2
  • James S. Tomlinson
    • 3
  • Ryan P. Merkow
    • 1
  • Andrew K. Stewart
    • 2
  • Clifford Y. Ko
    • 2
    • 3
  • Mark S. Talamonti
    • 1
  • David J. Bentrem
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Department of Surgery, Northwestern Memorial HospitalNorthwestern University, Feinberg School of MedicineChicagoUSA
  2. 2.Cancer ProgramsAmerican College of SurgeonsChicagoUSA
  3. 3.Department of SurgeryUniversity of California, Los Angeles (UCLA) and VA Greater Los Angeles Healthcare SystemLos AngelesUSA

Personalised recommendations