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World Journal of Surgery
Published in: World Journal of Surgery 7/2021

01-07-2021 | Neuroendocrine Tumor | Original Scientific Report

Recurrence of Non-functional Pancreatic Neuroendocrine Tumors After Curative Resection: A Tumor Burden-Based Prediction Model

Authors: Ding-Hui Dong, Xu-Feng Zhang, Alexandra G. Lopez-Aguiar, George Poultsides, Flavio Rocha, Sharon Weber, Ryan Fields, Kamran Idrees, Cliff Cho, Shishir K. Maithel, Timothy M. Pawlik

Published in: World Journal of Surgery | Issue 7/2021

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Abstract

Background

Patients can experience recurrence following curative-intent resection of non-functional pancreatic neuroendocrine tumors (NF-pNETs). We sought to develop a nomogram to risk stratify patients relative to recurrence following resection of NF-pNETs.

Methods

Patients who underwent curative-intent resection for NF-pNETs between 1997 and 2016 were identified from a multi-institutional database. The impact of clinicopathologic factors, including tumor burden score (TBS) (TBS2 = (maximum tumor diameter)2 + (number of tumors)2), was assessed relative to recurrence-free survival (RFS), and a nomogram was developed and internally validated.

Results

With a median follow-up of 31.0 months (IQR 11.3–56.6 months), 66 (15.8%) out of 416 patients in the cohort experienced tumor recurrence. Overall, 3-, 5-, and 10-year RFS following curative-intent resection was 83.2%, 74.0%, and 44.7%, respectively. Several factors were associated with risk of recurrence including tumor grade (referent G1: G2, HR 4.07, 95% CI 2.29–7.26, p < 0.001; G3, HR 10.83, 95% CI 3.72–31.53, p < 0.001), lymph node metastasis (LNM) (HR 4.71, 95% CI 2.69–8.26, p < 0.001), as well as TBS (referent low: medium, HR 4.36, 95% CI 2.06–9.24, p < 0.001; high, HR 6.04, 95% CI 2.96–12.31, p < 0.001). A weighted nomogram including tumor grade (G1 0, G2 54.19, G3 100), LNM (N0 0, N1 42.06), and TBS (low 0, medium 44.07, high 56.48) was developed. The discriminatory power of the nomogram was very good with a C-index of 0.75 (95% CI, 0.66–0.79) in the training cohort and 0.71 (95% CI, 0.65–0.75) in the validation cohort. In addition, the nomogram performed better than the current 8th edition of AJCC TNM staging system, which had a C-index of 0.67 (95% CI, 0.60–0.73).

Conclusions

A nomogram that incorporated tumor grade, LNM, and TBS was established that had good discrimination and calibration. The nomogram may be an effective tool to stratify patients relative to recurrence risk following resection of NF-pNETs.
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Metadata
Title
Recurrence of Non-functional Pancreatic Neuroendocrine Tumors After Curative Resection: A Tumor Burden-Based Prediction Model
Authors
Ding-Hui Dong
Xu-Feng Zhang
Alexandra G. Lopez-Aguiar
George Poultsides
Flavio Rocha
Sharon Weber
Ryan Fields
Kamran Idrees
Cliff Cho
Shishir K. Maithel
Timothy M. Pawlik
Publication date
01-07-2021
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 7/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-021-06020-8

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