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Surgical Treatment of Patients with Poorly Differentiated Pancreatic Neuroendocrine Carcinoma: An NCDB Analysis

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

Abstract

Background

Consensus guidelines discourage resection of poorly differentiated pancreatic neuroendocrine carcinoma (panNEC) given its association with poor long-term survival. This study assessed treatment patterns and outcomes for this rare malignancy using the National Cancer Database (NCDB).

Methods

Patients with non-functional pancreatic neuroendocrine tumors in the NCDB (2004–2016) were categorized based on pathologic differentiation. Logistic and Cox proportional hazard regressions identified associations with resection and overall survival (OS). Survival was compared using Kaplan-Meier and log-rank tests.

Results

Most patients (83%) in the cohort of 8560 patients had well-differentiated tumors (panNET). The median OS was 47 months (panNET, 63 months vs panNEC, 17 months; p < 0.001). Surgery was less likely for older patients (odds ratio [OR], 0.97), patients with panNEC (OR, 0.27), and patients with metastasis at diagnosis (OR, 0.08) (all p < 0.001). After propensity score-matching of these factors, surgical resection was associated with longer OS (82 vs 29 months; p < 0.001) and a decreased hazard of mortality (hazard ratio [HR], 0.37; p < 0.001). Surgery remained associated with longer OS when stratified by differentiation (98 vs 41 months for patients with panNET and 36 vs 8 months for patients with panNEC). Overall survival did not differ between patients with panNEC who underwent surgery and patients with panNET who did not (both 39 months; p = 0.294).

Conclusions

Poorly differentiated panNEC exhibits poorer survival than well-differentiated panNET. In the current cohort, surgical resection was strongly and independently associated with improved OS, suggesting that patients with panNEC who are suitable operative candidates should be considered for multimodality therapy, including surgery.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA

    Sarah R. Kaslow MD, MPH, Gerardo A. Vitiello MD, Katherine Prendergast MD, Leena Hani MBBS, Steven M. Cohen DO, Christopher Wolfgang MD, PHD, Russell S. Berman MD, Ann Y. Lee MD & Camilo Correa-Gallego MD

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  1. Sarah R. Kaslow MD, MPH
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  2. Gerardo A. Vitiello MD
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  3. Katherine Prendergast MD
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  4. Leena Hani MBBS
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Correspondence to Camilo Correa-Gallego MD.

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This work was presented at the Americas Hepato-Pancreato-Biliary Association 2021 Annual Meeting, August 2–5, 2021 in Miami, Florida.

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10434_2022_11477_MOESM2_ESM.png

FIG. S1 Covariate balance before propensity score-matching (entire cohort) and in the propensity score-matched cohort (PNG 28 kb)

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Kaslow, S.R., Vitiello, G.A., Prendergast, K. et al. Surgical Treatment of Patients with Poorly Differentiated Pancreatic Neuroendocrine Carcinoma: An NCDB Analysis. Ann Surg Oncol 29, 3522–3531 (2022). https://doi.org/10.1245/s10434-022-11477-5

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