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Well-differentiated grade 1 and 2 nonfunctioning pancreatic neuroendocrine tumor: Consideration of additional factors
Omid Salehi1, Ponnandai Somasundar2, N Joseph Espat2
1Department of Surgery, Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI, USA.
Background:
Guidelines for 1-2 cm well-differentiated non-functional pancreatic neuroendocrine tumors (NF-PNET) are broad; observation (OB), enucleation (EN), and pancreatic resection (PR) all viable. The objective is analyzing factors impacting survival between approaches.
Methods:
Retrospective analysis of NCDB for 1-2 cm well-differentiated grade 1/2 NF-PNET stratified by approach. Factors predicting survival analyzed using Cox regression.
Results:
4023 patients included; 1030 OB, 321 EN, and 2672 PR. EN was associated with improved survival (HR 0.20, 95 %CI 0.08-0.53) and was dependent on negative margins (margin negative: HR 0.12, 95 %CI 0.05-0.34). Positive margins for EN were high (29.7 % EN vs. 3.4 % PR, p < 0.01). Factors influencing margins for EN were pancreatic tail location (OR 0.36, 95 %CI 0.13-0.98) and lymphovascular invasion (OR 5.28, 95 %CI 1.42-19.53). Among PRs, only distal pancreatectomy conferred improved survival (HR 0.53, 95 %CI 0.30-0.92).
Conclusion:
Optimal treatment for 1-2 cm well-differentiated NF-PNET should incorporate factors influencing positive margins for EN and resection type for PR.
