Journal of Gastrointestinal Surgery

, Volume 15, Issue 1, pp 175–183 | Cite as

Analysis of 6,747 Pancreatic Neuroendocrine Tumors for a Proposed Staging System

  • Robert C. G. Martin
  • David A. Kooby
  • Sharon M. Weber
  • Nipun B. Merchant
  • Alex A. Parikh
  • Clifford S. Cho
  • Syed A. Ahmad
  • Hong Jin Kim
  • William Hawkins
  • Charles R. Scoggins
Original Article



Currently, no reasonable staging system exists for pancreatic neuroendocrine tumors (PNET) to guide treating physicians. The aim of this study was to devise a staging system of relevant prognostic factors to better predict overall survival in PNET.


A prospective 300 patient cohort and a review of the Surveillance Epidemiology and End Results database identified 6,447 patients with PNET from 1973 to 2008. Significant prognostic factors were created for an initial. Tumor: T (T1: ≤3 cm and localized to pancreas, T2: >3 cm and localized to the pancreas; T3: extension to adjacent organs and vessels), grade: G (G1: well/moderate and G2: poor/undifferentiated), and metastasis: M (M0: no distant mets, M1: distant mets) staging system.


Significant predictors of survival on multivariate analysis included age, size, grade, and metastasis. Based on the TGM staging system: stage 1 (T1–2, G1, M0), stage 2 (T1–2, G2, M0), stage 3 (T3G2M0, Tany, G1, M1), stage 4: (Tany, G2, M1) was created with survival being statistically different between stages (p < 0.0001). Median survival rates were stage 1, 55 months; stage 2, 50 months; stage 3, 46 months; and stage 4, 25 months.


Incorporation of this newly developed staging system into clinical practice will improve the ability to predict prognosis and aid in stratification of patients for clinical trials.


Pancreatic Neuroendocrine Staging 


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Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Robert C. G. Martin
    • 1
    • 8
  • David A. Kooby
    • 2
  • Sharon M. Weber
    • 3
  • Nipun B. Merchant
    • 4
  • Alex A. Parikh
    • 4
  • Clifford S. Cho
    • 3
  • Syed A. Ahmad
    • 5
  • Hong Jin Kim
    • 6
  • William Hawkins
    • 7
  • Charles R. Scoggins
    • 1
  1. 1.Department of SurgeryUniversity of Louisville HospitalLouisvilleUSA
  2. 2.Department of SurgeryEmory University HospitalAtlantaUSA
  3. 3.Department of SurgeryUniversity of Wisconsin HospitalMadisonUSA
  4. 4.Department of SurgeryVanderbilt University Medical CenterNashvilleUSA
  5. 5.Department of SurgeryUniversity of Cincinnati Medical CenterCincinnatiUSA
  6. 6.Department of SurgeryUniversity of North Carolina HospitalsChapel HillUSA
  7. 7.Department of SurgeryWashington University Medical CenterSt. LouisUSA
  8. 8.Department of SurgeryUniversity of Louisville School of MedicineLouisvilleUSA

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