TY - JOUR
T1 - A Novel Validated Recurrence Risk Score to Guide a Pragmatic Surveillance Strategy after Resection of Pancreatic Neuroendocrine Tumors
T2 - An International Study of 1006 Patients
AU - Zaidi, Mohammad Y.
AU - Lopez-Aguiar, Alexandra G.
AU - Switchenko, Jeffrey M.
AU - Lipscomb, Joseph
AU - Andreasi, Valentina
AU - Partelli, Stefano
AU - Gamboa, Adriana C.
AU - Lee, Rachel M.
AU - Poultsides, George A.
AU - Dillhoff, Mary
AU - Rocha, Flavio G.
AU - Idrees, Kamran
AU - Cho, Clifford S.
AU - Weber, Sharon M.
AU - Fields, Ryan C.
AU - Staley, Charles A.
AU - Falconi, Massimo
AU - Maithel, Shishir K.
N1 - Funding Information:
Sources of Support: Research reported in this publication was supported in part by the Katz Foundation Research grant and the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/ NCI under award number P30CA138292. The content is solely the responsi-bility of the authors and does not necessarily represent the official views of the National Institutes of Health. PhD Scholarship of Dr Valentina Andreasi was supported by Gioja Bianca Costanza Fund.
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Objective:Despite heterogeneous biology, similar surveillance schemas are utilized after resection of all pancreatic neuroendocrine tumors (PanNETs). Given concerns regarding excess radiation exposure and financial burden, our aim was to develop a prognostic score for disease recurrence to guide individually tailored surveillance strategies.Methods:All patients with primary nonfunctioning, nonmetastatic well/moderately differentiated PanNETs who underwent curative-intent resection at 9-institutions from 2000 to 2016 were included (n = 1006). A Recurrence Risk Score (RRS) was developed from a randomly selected derivation cohort comprised of 67% of patients and verified on the validation-cohort comprised of the remaining 33%.Results:On multivariable analysis, patients within the derivation cohort (n = 681) with symptomatic tumors (jaundice, pain, bleeding), tumors >2cm, Ki67 >3%, and lymph node (LN) (+) disease had increased recurrence. Each factor was assigned a score based on their weighted odds ratio that formed a RRS of 0 to 10: symptomatic = 1, tumor >2cm = 2, Ki67 3% to 20% = 1, Ki67 >20% = 6, LN (+) = 1. Patients were grouped into low-(RRS = 0-2; n = 247), intermediate-(RRS = 3-5; n = 204), or high (RRS = 6-10; n = 9)-risk groups. At 24 months, 33% of high RRS recurred, whereas only 2% of low and 14% of intermediate RRS recurred. This persisted in the validation cohort (n = 325).Conclusions:This international, novel, internally validated RRS accurately stratifies recurrence-free survival for patients with resected PanNETs. Given their unique recurrence patterns, surveillance intervals of 12, 6, and 3 months are proposed for low, intermediate, and high RRS patients, respectively, to minimize radiation exposure and optimize cost/resource utilization.
AB - Objective:Despite heterogeneous biology, similar surveillance schemas are utilized after resection of all pancreatic neuroendocrine tumors (PanNETs). Given concerns regarding excess radiation exposure and financial burden, our aim was to develop a prognostic score for disease recurrence to guide individually tailored surveillance strategies.Methods:All patients with primary nonfunctioning, nonmetastatic well/moderately differentiated PanNETs who underwent curative-intent resection at 9-institutions from 2000 to 2016 were included (n = 1006). A Recurrence Risk Score (RRS) was developed from a randomly selected derivation cohort comprised of 67% of patients and verified on the validation-cohort comprised of the remaining 33%.Results:On multivariable analysis, patients within the derivation cohort (n = 681) with symptomatic tumors (jaundice, pain, bleeding), tumors >2cm, Ki67 >3%, and lymph node (LN) (+) disease had increased recurrence. Each factor was assigned a score based on their weighted odds ratio that formed a RRS of 0 to 10: symptomatic = 1, tumor >2cm = 2, Ki67 3% to 20% = 1, Ki67 >20% = 6, LN (+) = 1. Patients were grouped into low-(RRS = 0-2; n = 247), intermediate-(RRS = 3-5; n = 204), or high (RRS = 6-10; n = 9)-risk groups. At 24 months, 33% of high RRS recurred, whereas only 2% of low and 14% of intermediate RRS recurred. This persisted in the validation cohort (n = 325).Conclusions:This international, novel, internally validated RRS accurately stratifies recurrence-free survival for patients with resected PanNETs. Given their unique recurrence patterns, surveillance intervals of 12, 6, and 3 months are proposed for low, intermediate, and high RRS patients, respectively, to minimize radiation exposure and optimize cost/resource utilization.
KW - cost savings
KW - neuroendocrine
KW - non-functional neuroendocrine tumor
KW - pancreatic neuroendocrine tumor
KW - surveillance
UR - http://www.scopus.com/inward/record.url?scp=85070960815&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000003461
DO - 10.1097/SLA.0000000000003461
M3 - Article
C2 - 31283562
AN - SCOPUS:85070960815
SN - 0003-4932
VL - 270
SP - 422
EP - 433
JO - Annals of Surgery
JF - Annals of Surgery
IS - 3
ER -