Prognostic factors after resection of locally advanced non-functional pancreatic neuroendocrine neoplasm: an analysis from the German Cancer Registry Group of the Society of German Tumor Centers

• Published in: Journal of cancer research and clinical oncology Vol. 149; no. 11; pp. 8535 - 8543
• Main Authors: Abdalla, Thaer S. A., Klinkhammer-Schalke, Monika, Zeissig, Sylke Ruth, Tol, Kees Kleihues-van, Honselmann, Kim C., Braun, Rüdiger, Bolm, Louisa, Lapshyn, Hryhoriy, Litkevych, Stanislav, Zemskov, Sergii, Begum, Nehara, Kulemann, Birte, Hummel, Richard, Wellner, Ulrich Friedrich, Keck, Tobias, Deichmann, Steffen
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2023; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Cancer Research; Female; Hematology; Humans; Internal Medicine; Lymph nodes; Lymphatic Metastasis; Lymphatic system; Male; Margins of Excision; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Neoplasm Staging; Neuroendocrine tumors; Neuroendocrine Tumors - pathology; Oncology; Pancreas; Pancreatic cancer; Pancreatic Neoplasms - pathology; Prognosis; Registries; Retrospective Studies; Risk groups; Survival; Tumors; Population-based analysis; Pancreatic neuroendocrine neoplasms; Resection margin; Prognostic factors
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-023-04785-0

Objective The available literature regarding outcome after pancreatic resection in locally advanced non-functional pNEN (LA-pNEN) is sparse. Therefore, this study evaluates the current survival outcomes and prognostic factors in after resection of LA-pNEN. Materials and methods This population-based analysis was derived from 17 German cancer registries from 2000 to 2019. Patients with upfront resected non-functional non-metastatic LA-pNEN were included. Results Out of 2776 patients with pNEN, 277 met the inclusion criteria. 137 (45%) of the patients were female. The median age was 63 ± 18 years. Lymph node metastasis was present in 45%. G1, G2 and G3 pNEN were found in 39%, 47% and 14% of the patients, respectively. Resection of LA-pNEN resulted in favorable 3-, 5- and 10-year overall survival of 79%, 74%, and 47%. Positive resection margin was the only potentially modifiable independent prognostic factor for overall survival (HR 1.93, 95% CI 1.71–3.69, p value = 0.046), whereas tumor grade G3 (HR 5.26, 95% CI 2.09–13.25, p value < 0.001) and lymphangiosis (HR 2.35, 95% CI 1.20–4.59, p value = 0.012) were the only independent prognostic factors for disease-free survival. Conclusion Resection of LA-pNEN is feasible and associated with favorable overall survival. G1 LA-pNEN with negative resection margins and absence of lymph node metastasis and lymphangiosis might be considered as cured, while those not fulfilling these criteria might be considered as a high-risk group for disease progression. Herein, negative resection margins represent the only potentially modifiable prognostic factor in LA-pNEN but seem to be influenced by tumor grade.