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Pancreatic grade 3 neuroendocrine tumors behave similarly to neuroendocrine carcinomas following resection: a multi-center, international appraisal of the WHO 2010 and WHO 2017 staging schema for pancreatic neuroendocrine lesions.
HPB ( IF 2.9 ) Pub Date : 2020-02-17 , DOI: 10.1016/j.hpb.2019.12.014
Patrick J Worth 1 , Julie Leal 2 , Qian Ding 1 , Amber Trickey 1 , Monica M Dua 1 , Nikolaos Chatzizacharias 3 , Zahir Soonawalla 4 , Panagiotis Athanasopoulos 5 , Christos Toumpanakis 5 , Paul Hansen 6 , Rowan W Parks 7 , Saxon Connor 8 , Kate Parker 9 , Jonathan Koea 9 , Sanket Srinavasa 9 , Benedetto Ielpo 10 , Emilio Vicente Lopez 10 , Benjamin Lawrence 9 , Brendan C Visser 1 ,
Affiliation  

Background

In 2017, the WHO updated their 2010 classification of pancreatic neuroendocrine tumors, introducing a well-differentiated, highly proliferative grade 3 tumor, distinct from neuroendocrine carcinomas. The aim of this study was to investigate the clinical significance of this update in a large cohort of resected tumors.

Methods

Using a multicenter, international dataset of patients with pancreatic neuroendocrine lesions, patients were classified both according to the WHO 2010 and 2017 schema. Multivariable survival analyses were performed, and the models were evaluated for discrimination ability and goodness of fit.

Results

Excluding patients with a known germline MEN1 mutation and incomplete data, 544 patients were analyzed. The performance of the WHO 2010 and 2017 models was similar, however surgically resected grade 3 tumors behaved very similarly to neuroendocrine carcinomas.

Conclusion

The addition of a grade 3 NET classification may be of limited utility in surgically resected patients, as these lesions have similar postoperative survival compared to carcinomas. While the addition may allow for a more granular evaluation of novel treatment strategies, surgical intervention for high grade tumors should be considered judiciously.



中文翻译:

胰腺 3 级神经内分泌肿瘤在切除后的表现与神经内分泌癌相似:对 WHO 2010 和 WHO 2017 胰腺神经内分泌病变分期方案的多中心国际评估。

背景

2017 年,WHO 更新了其 2010 年胰腺神经内分泌肿瘤的分类,引入了一种分化良好、高度增殖的 3 级肿瘤,与神经内分泌癌不同。本研究的目的是在一大群切除的肿瘤中调查此更新的临床意义。

方法

使用胰腺神经内分泌病变患者的多中心国际数据集,根据 WHO 2010 和 2017 模式对患者进行分类。进行多变量生存分析,并评估模型的辨别能力和拟合优度。

结果

排除已知种系 MEN1 突变和数据不完整的患者,分析了 544 名患者。WHO 2010 和 2017 模型的表现相似,但是手术切除的 3 级肿瘤的表现与神经内分泌癌非常相似。

结论

增加 3 级 NET 分类可能对手术切除的患者效用有限,因为与癌相比,这些病变具有相似的术后生存率。虽然添加可能允许对新的治疗策略进行更细致的评估,但应谨慎考虑对高级别肿瘤的手术干预。

更新日期:2020-02-17
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