Resection of pancreatic neuroendocrine tumors: defining patterns and time course of recurrence.,HPB

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Resection of pancreatic neuroendocrine tumors: defining patterns and time course of recurrence.
HPB ( IF 2.9 ) Pub Date : 2019-06-21 , DOI: 10.1016/j.hpb.2019.05.020
Ding-Hui Dong ₁ , Xu-Feng Zhang ₂ , Alexandra G Lopez-Aguiar ₃ , George Poultsides ₄ , Eleftherios Makris ₄ , Flavio Rocha ₅ , Zaheer Kanji ₅ , Sharon Weber ₆ , Alexander Fisher ₆ , Ryan Fields ₇ , Bradley A Krasnick ₇ , Kamran Idrees ₈ , Paula M Smith ₈ , Cliff Cho ₉ , Megan Beems ₉ , Mary Dillhoff ₁₀ , Shishir K Maithel ₃ , Timothy M Pawlik ₁₀

Affiliation

Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Division of Surgical Oncology, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Department of Surgery, Stanford University, Palo Alto, CA, USA.
Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Surgery, Washington University School of Medicine, St. Louis, WI, USA.
Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, TN, USA.
Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Division of Surgical Oncology, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.

Background

To define recurrence patterns and time course, as well as risk factors associated with recurrence following curative resection of pNETs.

Method

Patients who underwent curative-intent resection for pNET between 1997 and 2016 were identified from the US Neuroendocrine Tumor Study Group. Data on baseline and tumor-specific characteristics, overall survival (OS), timing and first-site of recurrence, predictors and recurrence management were analyzed.

Results

Among 1020 patients, 154 (15.1%) patients developed recurrence. Among patients who experienced recurrence, 76 (49.4%) had liver-only recurrence, while 35 (22.7%) had pancreas-only recurrence. The proportion of liver-only recurrence increased from 54.3% within one-year after surgery to 61.5% from four-to-six years after surgery; whereas the proportion of pancreas-only recurrence decreased from 26.1% to 7.7% over these time periods. While liver-only recurrence was associated with tumor characteristics, pancreas-only recurrence was only associated with surgical margin status. Patients undergoing curative resection of recurrence had comparable OS with patients who had no recurrence (median OS, pancreas-only recurrence, 133.9 months; liver-only recurrence, not attained; no recurrence, 143.0 months, p = 0.499)

Conclusions

Different recurrence patterns and timing course, as well as risk factors suggest biological heterogeneity of pNET recurrence. A personalized approach to postoperative surveillance and treatment of recurrence disease should be considered.

中文翻译：

胰腺神经内分泌肿瘤切除术：定义复发模式和时间进程。

背景

定义复发模式和时间过程，以及与 pNETs 根治性切除术后复发相关的风险因素。

方法

1997 年至 2016 年间接受根治性 pNET 切除术的患者来自美国神经内分泌肿瘤研究组。分析了有关基线和肿瘤特异性特征、总生存期 (OS)、复发时间和首发部位、预测因素和复发管理的数据。

结果

在 1020 名患者中，154 名 (15.1%) 患者出现复发。在经历复发的患者中，76 名 (49.4%) 仅出现肝脏复发，而 35 名 (22.7%) 仅出现胰腺复发。仅肝脏复发的比例从术后一年内的 54.3% 增加到术后四到六年的 61.5%；而在这些时间段内，仅胰腺复发的比例从 26.1% 下降到 7.7%。仅肝脏复发与肿瘤特征相关，而仅胰腺复发仅与手术切缘状态相关。接受复发根治性切除术的患者与未复发患者的 OS 相当（中位 OS，仅胰腺复发，133.9 个月；仅肝脏复发，未达到；无复发，143.0 个月，p = 0.499 ）