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Pancreatic Duct Involvement in Well-Differentiated Neuroendocrine Tumors is an Independent Poor Prognostic Factor

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

Abstract

Background

The biological behavior of well-differentiated neuroendocrine tumors of the pancreas (PNETs) is difficult to predict. This study was designed to determine whether involvement of the main pancreatic duct (MPD) serves as a poor prognostic factor for PNETs.

Methods

The involvement of the MPD in PNETs was defined as ductal stenosis inside the tumor mass associated with distal MPDs more than twofold larger in diameter than the proximal ducts. We examined the correlation between MPD involvement and other clinicopathological parameters, including nodal metastasis and recurrence-free survival, in 101 patients treated consecutively at three referral centers in Japan. All patients underwent surgical resection.

Results

MPD involvement was observed in 13 of the 101 cases (13%) and was associated with multiple unfavorable clinicopathological features (e.g., larger tumor size, higher histological grade, more frequent nodal metastasis, and higher recurrence rates). Patients with MPD involvement also showed significantly worse recurrence-free survival than did those without ductal involvement (P < 0.001), with a 5 years recurrence-free rate of 41%. On multivariate analysis, MPD involvement was significantly associated with nodal metastasis [odds ratio (OR) 16; 95% confidence interval (CI) 3.8–89; P < 0.001] and recurrence (OR 8.0; 95% CI 1.7–46; P = 0.009). The radiology–pathology correlation revealed that stenosis of the MPD was due to periductal and/or intraductal tumor invasion. Cases with MPD involvement had microscopic venous invasion (P = 0.010) and perineural infiltration (P = 0.002) more frequently than did those with no ductal infiltration.

Conclusions

MPD involvement in PNETs may serve as an imaging sign indicating an aggressive clinical course.

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Disclosures

All authors have no conflicts of interest and nothing to disclose.

Author information

Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoshihide Nanno MD, Hirochika Toyama MD, PhD, Sadaki Asari MD, PhD, Tadahiro Goto MD, PhD, Tetsuo Ajiki MD, PhD, Takumi Fukumoto MD, PhD & Yonson Ku MD, PhD

  2. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan

    Ippei Matsumoto MD, PhD & Yoshifumi Takeyama MD, PhD

  3. Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoh Zen MD, PhD, FRCPath & Kyoko Otani MD

  4. Department of Gastroenterological Surgery, Kagawa University Faculty of Medicine, Takamatsu, Kagawa, Japan

    Jun Uemura MD, Keiichi Okano MD, PhD & Yasuyuki Suzuki MD, PhD

Authors
  1. Yoshihide Nanno MD
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  2. Ippei Matsumoto MD, PhD
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  3. Yoh Zen MD, PhD, FRCPath
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  4. Kyoko Otani MD
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  6. Hirochika Toyama MD, PhD
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  7. Sadaki Asari MD, PhD
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  8. Tadahiro Goto MD, PhD
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  11. Yasuyuki Suzuki MD, PhD
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  12. Yoshifumi Takeyama MD, PhD
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  13. Takumi Fukumoto MD, PhD
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  14. Yonson Ku MD, PhD
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Corresponding author

Correspondence to Ippei Matsumoto MD, PhD.

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Nanno, Y., Matsumoto, I., Zen, Y. et al. Pancreatic Duct Involvement in Well-Differentiated Neuroendocrine Tumors is an Independent Poor Prognostic Factor. Ann Surg Oncol 24, 1127–1133 (2017). https://doi.org/10.1245/s10434-016-5663-8

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  • DOI: https://doi.org/10.1245/s10434-016-5663-8

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