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An Orthotopic Resectional Mouse Model of Pancreatic Cancer
Published on: September 24, 2020
Observational study of surgical resection in small non-functional pancreatic neuroendocrine tumors: AS SEER-based
1Department of General Surgery, Fujian Medical University Union Hospital, #29 Xinquan Road, Fuzhou, 350001, People's Republic of China.
Abstract:
The potential benefits of surgical resection for small non-functional pancreatic neuroendocrine tumors (NF-PNETs) in terms of survival remain uncertain. This study aimed to evaluate the impact of surgical treatment on patients with NF-PNETs. Using SEER data, we identified 1102 patients from 2004 to 2015 with well and moderately differentiated pancreatic neuroendocrine tumors (PNETs). The associations between continuous variables and receipt of surgery were assessed using Wilcoxon rank-sum tests. Kaplan-Meier survival curves for OS were compared using the log-rank test. We compared outcomes in patients who received surgical resection with those in patients who did not, using a univariable Cox model with inverse probability weighting according to the propensity score and propensity-score matching. Among the cohort of 1102 patients, a majority of 965 individuals (87%) underwent surgical intervention. Upon conducting univariate analysis, we observed that surgical treatment significantly prolonged patients' survival [HR = 0.41, 95% CI [0.26-0.65] P < 0.001]. However, the old [HR = 3.27, 95% CI (2.24-4.76), P 0.001], male gender [HR = 1.82, 95% CI (1.23-2.68), P = 0.003], and moderately well-differentiated factors [HR = 1.71, 95% CI (1.04-2.80), P = 0.034] were found to potentially decrease patients' survival time. In the multivariate analysis, male gender [HR = 1.73, 95% CI (1.15-2.61), P = 0.009] and the old factor [HR = 3.52, 95% CI (2.33-5.31), P < 0.001] emerged as influential predictors with higher hazard ratios. Notably, surgical treatment remained a significant factor associated with improved overall survival [HR = 0.53, 95% CI (0.33-0.84), P = 0.007]. Propensity-score matching and inverse probability weighting were employed as analytical techniques. The univariate analysis results showed favorable outcomes in the weight group [HR = 0.48, 95% CI (0.29-0.78), P = 0.003] and matched group [HR = 0.44, 95% CI (0.22-0.85), P = 0.015], respectively. Survival analysis further confirmed that surgical treatment contributed to increased overall survival (log rank, P < 0.05) in both the matching and weight groups. Patients diagnosed with small, non-functioning pancreatic neuroendocrine tumors who undergo surgical intervention exhibit improved overall survival (OS) outcomes. Therefore, surgery is strongly recommended for this patient population.
Insights
Surgical resection significantly improves overall survival for patients with small, non-functional pancreatic neuroendocrine tumors (NF-PNETs). This study recommends surgery for this patient group, highlighting its positive impact on long-term outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- The survival benefits of surgical resection for small, non-functional pancreatic neuroendocrine tumors (NF-PNETs) are not well-established.
- Pancreatic neuroendocrine tumors (PNETs) represent a heterogeneous group of neoplasms requiring careful treatment stratification.
Purpose of the Study:
- To evaluate the impact of surgical treatment on the overall survival (OS) of patients diagnosed with NF-PNETs.
- To identify prognostic factors influencing survival in patients with PNETs.
Main Methods:
- Retrospective analysis of 1102 patients with well and moderately differentiated PNETs from the SEER database (2004-2015).
- Utilized Wilcoxon rank-sum tests, Kaplan-Meier curves with log-rank tests, univariable Cox models, inverse probability weighting, and propensity-score matching.
- Multivariate analysis was performed to identify independent predictors of survival.
Main Results:
- Surgical intervention was performed in 87% of the cohort, significantly prolonging overall survival (Univariate HR=0.41, P<0.001; Multivariate HR=0.53, P=0.007).
- Older age (HR=3.52, P<0.001) and male gender (HR=1.73, P=0.009) were associated with decreased survival.
- Propensity-score matching and inverse probability weighting confirmed the survival benefit of surgery (P<0.05).
Conclusions:
- Surgical resection is associated with significantly improved overall survival in patients with small, non-functional pancreatic neuroendocrine tumors.
- Age and male gender are independent predictors of reduced survival in PNET patients.
- Surgical intervention should be strongly considered for patients diagnosed with NF-PNETs.
