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A Survival Analysis of Patients with Localized, Asymptomatic Pancreatic Neuroendocrine Tumors: No Surgical Survival Benefit when Examining Appropriately Selected Outcomes

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Surgical resection for asymptomatic, localized, well-differentiated pancreatic neuroendocrine tumors (PNETs) is common yet controversial. Studies using overall survival as an endpoint have shown a benefit for resection; however, these results may be due to treatment selection bias. We assessed the impact of surgery on both overall (OS) and cancer-specific survival (CSS) for asymptomatic patients with stage I PNETs (AJCC 8th edition).

Methods

Using SEER data, we identified 709 patients from 2007 to 2015 with well- and moderately differentiated stage I PNETs. We performed Kaplan–Meier survival estimates and adjusted Cox regression for OS and CSS.

Results

Among 709 patients, 628 (88.6%) underwent surgery. There were 37 overall deaths and 11 cancer-specific deaths. All cancer-specific deaths occurred within 3 years of diagnosis. Five-year OS and CSS rates were 89% and 98%, respectively, for the population. Five-year OS rates were 56% in the non-surgical cohort versus 92% in the surgical cohort (log rank, p < 0.001). However, the 5-year CSS rates were similar; 94% in the non-surgical group and 98% in the surgical group (log rank, p  = 0.207). On multivariable analysis, surgery predicted improved OS but not CSS.

Conclusion

Although OS is superior in surgically treated stage I PNETs, CSS is not improved, implying treatment selection bias towards surgery being performed in healthier patients. These data suggest that overall survival is a problematic endpoint for the study of asymptomatic, stage I PNETs. Surgery should be individualized for this cohort of patients as the primary cause of death is non-cancer related.

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Acknowledgments

The authors thank Diana Castillo for her assistance with figure preparation.

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Authors and Affiliations

  1. Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL, 33612, USA

    Benjamin D. Powers, Luke D. Rothermel, Jason B. Fleming, Jonathan R. Strosberg & Daniel A. Anaya

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  1. Benjamin D. Powers
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  2. Luke D. Rothermel
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Each author participated in the work to take public responsibility for appropriate portions of the content as per the guidelines of the International Committee of Medical Journal Editors (ICMJE). All authors made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND drafting the work or revising it critically for important intellectual content; AND final approval of the version to be published; AND 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.

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Correspondence to Benjamin D. Powers.

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Powers, B.D., Rothermel, L.D., Fleming, J.B. et al. A Survival Analysis of Patients with Localized, Asymptomatic Pancreatic Neuroendocrine Tumors: No Surgical Survival Benefit when Examining Appropriately Selected Outcomes. J Gastrointest Surg 24, 2773–2779 (2020). https://doi.org/10.1007/s11605-019-04433-4

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