TY - JOUR
T1 - Therapeutic index of lymphadenectomy among patients with pancreatic neuroendocrine tumors
T2 - A multi-institutional analysis
AU - and other members of the U.S. Neuroendocrine Tumor Study Group
AU - Wu, Lu
AU - Sahara, Kota
AU - Tsilimigras, Diamantis I.
AU - Maithel, Shishir K.
AU - Poultsides, George A.
AU - Rocha, Flavio G.
AU - Weber, Sharon M.
AU - Fields, Ryan C.
AU - Idrees, Kamran
AU - Cho, Clifford S.
AU - Shen, Feng
AU - Pawlik, Timothy M.
N1 - Funding Information:
Jordan Cloyd, Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio; Mary Dillhoff, Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio; Alexandra G. Lopez-Aguiar, Department of Surgery, Emory University, Atlanta, GA; Eleftherios Makris, Department of Surgery, Stanford University, Stanford, CA; Zaheer Kanji, Department of Surgery, Virginia Mason Medical Center, Seattle; Alexander Fisher, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Bradley A. Krasnick, Department of Surgery, Washington University School of Medicine, St Louis, MO; Paula M. Smith, Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, TN; Megan Beems, Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Background: The benefit derived from lymph node dissection (LND) in patients with pancreatic neuroendocrine tumors (pNETs) based on clinicopathological characteristics remains unclear. Methods: Patients undergoing surgery for pNET between 1997 and 2016 were identified using a multi-institutional dataset. The therapeutic index of LND relative to patient characteristics was calculated. Results: Among 647 patients, the median number of lymph nodes (LNs) evaluated was 10 (interquartile range: 4-16) and approximately one quarter of patients had lymph node metastasis (LNM) (N = 159, 24.6%). Among patients with LNM, 5-year recurrence-free survival was 56.0%, reflecting a therapeutic index value of 13.8. The therapeutic index was highest among patients with a moderately/poorly-differentiated pNET (21.5), Ki-67 ≥ 3% (20.1), tumor size ≥2.0 cm (20.0), and tumor location at the head of the pancreas (20.0). Patients with ≥8 LNs evaluated had a higher therapeutic index than patients who had 1 to 7 LNs evaluated (≥8: 17.9 vs 1-7: 7.5; difference of index: 11.4). Conclusion: LND was mostly beneficial among patients with pNETs >2 cm, Ki-67 ≥ 3%, and lesions located at the pancreatic head as identification of LNM was most common among individuals with these tumor characteristics. Evaluation of ≥8 LNs was associated with a higher likelihood of identifying LNM as well as a higher therapeutic index, and therefore this number of LNs should be considered the goal.
AB - Background: The benefit derived from lymph node dissection (LND) in patients with pancreatic neuroendocrine tumors (pNETs) based on clinicopathological characteristics remains unclear. Methods: Patients undergoing surgery for pNET between 1997 and 2016 were identified using a multi-institutional dataset. The therapeutic index of LND relative to patient characteristics was calculated. Results: Among 647 patients, the median number of lymph nodes (LNs) evaluated was 10 (interquartile range: 4-16) and approximately one quarter of patients had lymph node metastasis (LNM) (N = 159, 24.6%). Among patients with LNM, 5-year recurrence-free survival was 56.0%, reflecting a therapeutic index value of 13.8. The therapeutic index was highest among patients with a moderately/poorly-differentiated pNET (21.5), Ki-67 ≥ 3% (20.1), tumor size ≥2.0 cm (20.0), and tumor location at the head of the pancreas (20.0). Patients with ≥8 LNs evaluated had a higher therapeutic index than patients who had 1 to 7 LNs evaluated (≥8: 17.9 vs 1-7: 7.5; difference of index: 11.4). Conclusion: LND was mostly beneficial among patients with pNETs >2 cm, Ki-67 ≥ 3%, and lesions located at the pancreatic head as identification of LNM was most common among individuals with these tumor characteristics. Evaluation of ≥8 LNs was associated with a higher likelihood of identifying LNM as well as a higher therapeutic index, and therefore this number of LNs should be considered the goal.
KW - lymphadenectomy
KW - pancreatic neuroendocrine tumor
KW - therapeutic index
UR - http://www.scopus.com/inward/record.url?scp=85071378987&partnerID=8YFLogxK
U2 - 10.1002/jso.25689
DO - 10.1002/jso.25689
M3 - Article
C2 - 31468550
AN - SCOPUS:85071378987
SN - 0022-4790
VL - 120
SP - 1080
EP - 1086
JO - Journal of Surgical Oncology
JF - Journal of Surgical Oncology
IS - 7
ER -