Abstract
Background
With the update and release of the newest version of WHO classification (2019) for neuroendocrine neoplasm, the clinical features, risk factors of prognosis and the effect of surgical treatment on newly classified pancreatic neuroendocrine carcinoma (pNEC) patients with liver metastasis were not deeply analyzed. In the present study, we tried to reveal the clinical features, and prognostic factors of pNEC patients with liver metastasis with the newest definition of WHO 2019, and explore whether primary tumor resection (PTR), chemotherapy and radiotherapy affect overall survival (OS) and cancer-specific survival (CSS) in those patients.
Methods
We collected data from pNEC patients with liver metastasis from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed between 2010 and 2019. We strictly selected pNEC patients according to the 2019 WHO classification criteria. The univariate and multivariate Cox regression analysis were used to determine independent predictors of the survival of these patients. The forest plots map was drawn by R-4.2.2 software to display the results of the multivariate analysis visually. Kaplan–Meier method was used to estimate the OS and CSS. Based on the multivariate analysis outcomes, we established the predictable nomogram model to predict the prognosis of pNEC patients with liver metastasis. The calibration plots were shown to prove the predictive value of the nomogram predictable model.
Results
We identified 205 eligible pNEC patients with liver metastasis. According to the multivariable Cox regression analysis in this study, we found that PTR, chemotherapy, primary tumor size and diagnosis to treatment time were independent prognostic factors for both OS and CSS. Kaplan–Meier survival curves demonstrated that PTR and chemotherapy were correlated with increased survival for pNEC patients with liver metastasis. The accuracy of the nomogram model was visually proved by the calibration plot with acceptable predictive performance.
Conclusion
Four independent predictors of prognosis in pNEC patients with liver metastasis were identified in this study, including PTR, chemotherapy, tumor size and diagnosis to treatment time. PTR and chemotherapy for pNEC with liver metastasis could lead to a better prognosis, which may provide inspiration for practical clinical guidelines.
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Data availability
All data were extracted from the SEER database (US National Cancer Institute).
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Acknowledgements
We acknowledge all the SEER database founders and data providers who made such studies possible. Thank you so much for making the SEER database available to us. We acknowledge the clinic staff and managers of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College for their valuable contributions to this research.
Funding
Research grant supports were provided by the National Key R&D Program of China (2018YFE0118600); National Natural Science Foundation of China (No.81972258, No.81974376, No. 82103016, No. 82172836, No.82272917, No.82203158); CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-1-I2M-002); China Postdoctoral Science Foundation (2021T140071 and 2021M690462); Youth Research Fund of Peking Union Medical College Hospital (pumch201911710, pumch201910819); National High Level Hospital Clinical Research Funding (2022-PUMCH-A-056; 2022-PUMCH-A-133; 2022-PUMCH-A-245); National Multidisciplinary Cooperative Diagnosis and Treatment Capacity Building Project for Major Diseases.
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LWH conceived the original idea, collected the data, analyzed the data and wrote the manuscript. ZTP supervised the project. All authors reviewed the manuscript.
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All data were extracted from the SEER database (US National Cancer Institute) in this study. No relevant approval was required for the study according to the policy of Peking Union Medical College Hospital.
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Luo, W., Zhang, T. Primary tumor resection enhances the survival of pancreatic neuroendocrine carcinoma patients with liver metastasis under the definition of 2019 WHO classification. J Cancer Res Clin Oncol 149, 9201–9212 (2023). https://doi.org/10.1007/s00432-023-04847-3
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DOI: https://doi.org/10.1007/s00432-023-04847-3