Surgical Outcomes, Long-Term Survivals and Staging Systems of World Health Organization G3 Pancreatic Neuroendocrine Tumors
Abstract
:1. Introduction
2. Methods
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Factor | Patients (n = 80) | |
---|---|---|
No. | % | |
Patients’ gender, female | 50 | 62.5 |
Patients’ age at diagnosis, years | 50 (7–74) | |
Tumor largest diameter, cm | 4.5 (1.8–8.5) | |
Tumor location, pancreatic body/tail | 51 | 63.8 |
Tumor number, solitary | 71 | 88.8 |
Tumor type, non-functional | 54 | 67.5 |
Incidental diagnosis | 15 | 18.8 |
Ki-67 proliferation index, % | 28 (21–60) | |
Mitotic rate, per 10 HPFs | 22 (20–38) | |
Presence of CgA | 80 | 100 |
Presence of necrosis | 10 | 12.5 |
No. lymph nodes harvested (median) | 8 (4–14) | |
T classification by both TNM systems A | ||
T1 | 12 | 15.0 |
T2 | 14 | 17.5 |
T3 | 32 | 40.0 |
T4 | 22 | 27.5 |
Nodal metastasis (n = 24) | ||
1–3 regional lymph node metastases | 15 | 18.8 |
≥4 regional lymph node metastases | 9 | 11.3 |
Distant metastasis | 13 | 16.3 |
Current AJCC 8th staging system | ||
Stage I | 5 | 6.3 |
Stage II | 35 | 43.8 |
Stage III | 27 | 33.8 |
Stage IV | 13 | 16.1 |
Proposed mTNM staging system | ||
Stage I | 9 | 11.3 |
Stage II | 27 | 33.8 |
Stage III | 31 | 38.8 |
Stage IV | 13 | 16.1 |
Factor | Patients (n = 80) | |
---|---|---|
No. | % | |
Operation classification, surgical resection | 62 | 77.5 |
Surgical margin (n = 62), radical A | 56 | 90.3 |
Surgical procedures | ||
Local resection of pancreatic tumor (enucleation included) | 11 | 13.8 |
Distal pancreatectomy | 28 | 35.0 |
Pancreaticoduodenectomy | 17 | 21.3 |
Radical resection for metastatic disease | 6 | 7.5 |
Palliative operation with biopsy B | 18 | 22.5 |
Anesthesia grade by ASA | ||
I | 9 | 11.2 |
II | 23 | 28.8 |
III | 30 | 37.5 |
IV | 18 | 22.5 |
V | 0 | 0 |
Volume of perioperative blood transfusion (n = 24), mL | 300 (100–1000) | |
Duration of operation, min. | 150 (40–340) | |
Duration of ICU in-hospital stay (n = 15), d. | 3 (1–9) | |
Duration of postoperative in-hospital stay, d. | 6 (3–15) | |
Duration of total in-hospital stay, d. | 9 (6–20) | |
Postoperative complications (n = 21) | ||
Pancreatic fistula | 10 | 12.5 |
Intra-abdominal infection | 7 | 8.8 |
Delayed gastric emptying | 4 | 5.0 |
Intra-abdominal hemorrhage | 2 | 2.5 |
Reoperation | 1 | 1.3 |
In-hospital death | 0 | 0 |
Postoperative medical therapy (n = 34) | ||
Novel molecular targeting treatment | 14 | 17.5 |
Traditional chemotherapy | 20 | 25 |
Patient prognosis | ||
Follow-up time, mon | 58.3 (9.7–182.6) | |
Out of contact | 10 | 12.5 |
Dead at follow-up (n = 70) | 39 | 55.7 |
Accumulative 5-year OS | 29.7% | |
MST, months | 49.2 (95% CIs: 41.8–56.5) |
Factor | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
HR (95% CIs) | p | HR (95% CIs) | p | |
Patients’ gender | ||||
Male A | ||||
Female | 1.244 (0.864–1.653) | 0.236 | ||
Patients’ age | ||||
<50 B | ||||
≥50 | 0.931 (0.512–1.349) | 0.121 | ||
Tumor location | ||||
Head/uncinate | ||||
Body/tail | 1.012 (0.626–1.431) | 0.415 | ||
Tumor type | ||||
Functional | ||||
Non-functional1 | 1.425 (0.712–2.324) | 0.012 | 1.034 (0.523–1.517) | 0.512 C |
1.213 (0.671–1.642) | 0.214 D | |||
Incidental diagnosis | ||||
No | ||||
Yes | 0.973 (0.5157–1.436) | 0.478 | ||
Tumor diameter | ||||
<4.5 | ||||
≥4.5 | 1.479 (0.762–2.962) | 0.016 | 0.783 (0.361–1.452) | 0.257 |
0.981 (0.382–1.901) | 0.538 | |||
Ki-67 index | ||||
<28 | ||||
≥28 | 2.069 (0.982–4.123) | 0.035 | 1.253 (0.564–2.122) | 0.873 |
0.902 (0.468–2.093) | 0.435 | |||
Mitotic rate | ||||
<22 | ||||
≥22 | 1.214 (0.614–1.892) | 0.125 | ||
Necrosis | ||||
Absent | ||||
Present | 3.024 (1.243–7.146) | 0.027 | 1.441 (0.684–2.679) | 0.137 |
0.993 (0.414–1.983) | 0.561 | |||
Harvested lymph nodes | ||||
<8 | ||||
≥8 | 1.001 (0.425–1.458) | 0.512 | ||
Operation classification | ||||
Resection | ||||
Palliative | 2.221 (1.329–4.186) | <0.001 | 1.523 (0.723–3.215) | 0.031 |
1.734 (0.757–3.953) | 0.027 | |||
Duration of operation | ||||
<150 | ||||
≥150 | 1.275 (0.546–2.325) | 0.343 | ||
Duration of postoperative in-hospital stay | ||||
<6 | ||||
≥6 | 1.241 (0.547–1.874) | 0.952 | ||
Postoperative complications | ||||
No | ||||
Yes | 0.893 (0.434–2.082) | 0.517 | ||
Postoperative medical therapy | ||||
No | ||||
Yes | 2.145 (0.783–3855) | 0.042 | 1.314 (0.424–2.325) | 0.518 |
1.211 (0.384–1.924) | 0.892 | |||
Current AJCC 8th staging system E | ||||
Stage I/II | ||||
Stage III/IV | 3.124 (1.322–5.478) | <0.001 | 5.363 (0.329–10.013) | 0.017 |
NA | ||||
Proposed mTNM staging system E | ||||
Stage I/II | ||||
Stage III/IV | 3.954 (0.996–8.326) | <0.001 | NA | |
3.213 (0.626–8.217) | 0.032 |
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Yang, M.; Zeng, L.; Hou, S.; Tian, B.; Jin, S.; Zhang, Y. Surgical Outcomes, Long-Term Survivals and Staging Systems of World Health Organization G3 Pancreatic Neuroendocrine Tumors. J. Clin. Med. 2022, 11, 5253. https://doi.org/10.3390/jcm11185253
Yang M, Zeng L, Hou S, Tian B, Jin S, Zhang Y. Surgical Outcomes, Long-Term Survivals and Staging Systems of World Health Organization G3 Pancreatic Neuroendocrine Tumors. Journal of Clinical Medicine. 2022; 11(18):5253. https://doi.org/10.3390/jcm11185253
Chicago/Turabian StyleYang, Min, Lin Zeng, Shengzhong Hou, Bole Tian, Shuguang Jin, and Yi Zhang. 2022. "Surgical Outcomes, Long-Term Survivals and Staging Systems of World Health Organization G3 Pancreatic Neuroendocrine Tumors" Journal of Clinical Medicine 11, no. 18: 5253. https://doi.org/10.3390/jcm11185253
APA StyleYang, M., Zeng, L., Hou, S., Tian, B., Jin, S., & Zhang, Y. (2022). Surgical Outcomes, Long-Term Survivals and Staging Systems of World Health Organization G3 Pancreatic Neuroendocrine Tumors. Journal of Clinical Medicine, 11(18), 5253. https://doi.org/10.3390/jcm11185253