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Factors Affecting Nonfunctioning Small Pancreatic Neuroendocrine Neoplasms and Proposed New Treatment Strategies
Susumu Hijioka1, Daiki Yamashige1, Minoru Esaki2
1Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan.
Summary
Treatment for small pancreatic neuroendocrine neoplasms (PNENs) should consider tumor grade, not just size. Higher grades (NET-G2+) and larger sizes (≥15 mm) indicate higher risks of metastasis and recurrence, necessitating personalized strategies.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endocrinology
Background:
- Uncertainties remain regarding optimal treatment strategies for nonfunctioning small pancreatic neuroendocrine neoplasms (NF-spNENs) ≤20 mm.
- A large Japanese cohort was analyzed to address these uncertainties.
Purpose of the Study:
- To evaluate surgically resected NF-spNENs in a large Japanese cohort.
- To elucidate an optimal treatment strategy for NF-spNENs.
Main Methods:
- Retrospective analysis of patients who underwent pancreatectomy between January 1996 and December 2019.
- Inclusion of cases pathologically diagnosed with pNEN according to WHO 2019 classification.
- Analysis of 1014 patients from a multicenter Japanese study.
Main Results:
- NF-spNENs are heterogeneous; 82% were grade 1 (NET-G1) and 18% were grade 2 (NET-G2) or higher.
- Lymph node metastasis (N1) was significantly higher in NET-G2 (15.0%) vs NET-G1 (3.1%).
- Independent predictors for N1 included NET-G2+ and tumor diameter ≥15 mm; predictors for recurrence included multiple lesions, NET-G2+, tumor diameter ≥15 mm, and N1. Tumor grade was the sole independent predictor for survival.
Conclusions:
- Treatment strategies solely based on tumor size for NF-spNENs can be unreliable due to their heterogeneity.
- Personalized treatment strategies incorporating tumor grading are preferable for managing NF-spNENs.
- Optimal resection timing varied by grade: >20 mm for NET-G1 and >10 mm for NET-G2+; >15 mm for unknown preoperative grades.
