Outcome after pancreatectomy for neuroendocrine neoplams according to the WHO 2017 grading system: A retrospective multicentric analysis of 138 consecutive patients - 20/06/20
, Antoine Coignac a, b, Marie Dupuy c, Martin Bertrand d, Isabelle Raingeart e, Boris Guiu f, Astrid Herrero a, b, Fabrizio Panaro a, b, Stephane Obled g, Fabienne Portales h, Benjamin Riviere i, Jeanne Ramos i, Frederic Borie d, Francois Quenet j, Pierre-Emmanuel Colombo j, Michel Prudhomme d, Eric Assenat c, Jean-Michel Fabre a, bRenaten Languedoc-Roussillon Study Group
Réseau de référence clinique pour les tumeurs endocrines malignes sporadiques et héréditairesa, b, c, d, e, f, g, h, i, j
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Highlights |
• | The WHO 2017 grading system is a useful tool for patient prognosis after and the tailoring of therapeutic strategy. |
• | The WHO 2017 grading system, age and distant metastasis were independent predictors of worse survival. |
• | Symptomatic panNET, lymph node metastasis were independently associated with disease recurrence. |
• | PanNET G3 has an intermediate prognosis between panNET G2 and PNEC. |
• | Progress in diagnosis tools to distinguish panNET G3 vs. PNEC are required. |
Summary |
Aim |
The aim of this study was to evaluate the new World Health Organization (WHO) 2017 grading system and the others clinicopathological factors in pancreatic neuroendocrine tumor (panNET) operated patients.
Methods |
Histological staging was based on the WHO 2017 grading system. Outcome after surgery and predictors of overall survival (OS) and disease free survival (DFS) were evaluated.
Results |
A total of 138 patients underwent surgical resection with a severe morbidity and mortality rates of 14.5% and 0.7% respectively. Five years OS differed according to WHO 2017: 95% among 58 patients with NETG1, 82% in 68 patients with NETG2, 35% in 7 patients with NETG3 and 0% in 5 patients with NECG3 (P<0.0001). Independent predictors of worse OS were age>60 y.o (P=0.014), synchronous metastasis (P=0.005) and WHO 2017 with significant differences between NETG1 versus NETG2 (P=0.005), NETG3 (P<0.001) and NECG3 (P<0.001). Independent predictors of worse DFS were symptomatic NET (P=0.038), pN+ status (P=0.027) and WHO 2017 with significant differences between NETG1 versus NETG3 (P=0.014) and NECG3 (P=0.009).
Conclusion |
The WHO 2017 grading system is a useful tool for patient prognosis after panNET resection and the tailoring of therapeutic strategy. Surgery could provide good results in NETG3 patients.
El texto completo de este artículo está disponible en PDF.Keywords : Pancreatectomy, Surgery, Neuroendocrine tumor, Postoperative outcome, Pancreas
Esquema
Vol 44 - N° 3
P. 286-294 - juin 2020 Regresar al número
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