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Histogram array and convolutional neural network of DWI for differentiating pancreatic ductal adenocarcinomas from solid pseudopapillary neoplasms and neuroendocrine neoplasms. Clin Imaging 2023; 96:15-22. [PMID: 36736182 DOI: 10.1016/j.clinimag.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE This study aimed to investigate the diagnostic performance of the histogram array and convolutional neural network (CNN) based on diffusion-weighted imaging (DWI) with multiple b-values under magnetic resonance imaging (MRI) to distinguish pancreatic ductal adenocarcinomas (PDACs) from solid pseudopapillary neoplasms (SPNs) and pancreatic neuroendocrine neoplasms (PNENs). METHODS This retrospective study consisted of patients diagnosed with PDACs (n = 132), PNENs (n = 45) and SPNs (n = 54). All patients underwent 3.0-T MRI including DWI with 10 b values. The regions of interest (ROIs) of pancreatic tumor were manually drawn using ITK-SNAP software, which included entire tumor at DWI (b = 1500 s/m2). The histogram array was obtained through the ROIs from multiple b-value data. PyTorch (version 1.11) was used to construct a CNN classifier to categorize the histogram array into PDACs, PNENs or SPNs. RESULTS The area under the curves (AUCs) of the histogram array and the CNN model for differentiating PDACs from PNENs and SPNs were 0.896, 0.846, and 0.839 in the training, validation and testing cohorts, respectively. The accuracy, sensitivity and specificity were 90.22%, 96.23%, and 82.05% in the training cohort, 84.78%, 96.15%, and 70.0% in the validation cohort, and 81.72%, 90.57%, and 70.0% in the testing cohort. The performance of CNN with AUC of 0.865 for this differentiation was significantly higher than that of f with AUC = 0.755 (P = 0.0057) and α with AUC = 0.776 (P = 0.0278) in all patients. CONCLUSION The histogram array and CNN based on DWI data with multiple b-values using MRI provided an accurate diagnostic performance to differentiate PDACs from PNENs and SPNs.
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Sulciner ML, Clancy TE. Surgical Management of Pancreatic Neuroendocrine Tumors. Cancers (Basel) 2023; 15:cancers15072006. [PMID: 37046665 PMCID: PMC10093271 DOI: 10.3390/cancers15072006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Pancreatic neuroendocrine tumors (PNETs) are relatively uncommon malignancies, characterized as either functional or nonfunctional secondary to their secretion of biologically active hormones. A wide range of clinical behavior can be seen, with the primary prognostic indicator being tumor grade as defined by the Ki67 proliferation index and mitotic index. Surgery is the primary treatment modality for PNETs. While functional PNETs should undergo resection for symptom control as well as potential curative intent, nonfunctional PNETs are increasingly managed nonoperatively. There is increasing data to suggest small, nonfunctional PNETs (less than 2 cm) are appropriate follow with nonoperative active surveillance. Evidence supports surgical management of metastatic disease if possible, and occasionally even surgical management of the primary tumor in the setting of widespread metastases. In this review, we highlight the evolving surgical management of local and metastatic PNETs.
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EMT Molecular Signatures of Pancreatic Neuroendocrine Neoplasms. Int J Mol Sci 2022; 23:ijms232113645. [PMID: 36362433 PMCID: PMC9657865 DOI: 10.3390/ijms232113645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Neuroendocrine neoplasms (NENs) are relatively rare neoplasms occurring predominantly in the gastrointestinal tract and pancreas. Their heterogeneity poses challenges for diagnosis and treatment. There is a paucity of markers for characterisation of NEN tumours. For routine diagnosis, immunohistochemistry of the NEN-specific markers CgA and synaptophysin and the proliferation marker Ki-67 are used. These parameters, however, are qualitative and lack the capacity to fully define the tumour phenotype. Molecules of epithelial–mesenchymal transition (EMT) are potential candidates for improved tumour characterisation. Using qRT-PCR, we measured mRNA levels of 27 tumour markers, including 25 EMT-associated markers, in tumour tissue and matched non-tumour tissues for 13 patients with pancreatic NENs. Tissue from patients with three different grades of tumour had distinctly different mRNA profiles. Of the 25 EMT-associated markers analysed, 17 were higher in G3 tissue relative to matched non-tumour tissue, including CD14, CD24, CD31, CD44, CD45, CD56, CK6, CK7, CK13, CK20, NSE, CDX2, CgA, DAXX, PCNA, laminin and Ki-67. The differences in levels of seven EMT-associated markers, Ki-67, DAXX, CD24, CD44, vimentin, laminin and PDX1 plus CgA and NSE (neuroendocrine markers) enabled a distinct molecular signature for each tumour grade to be generated. EMT molecules differentially expressed in three tumour grades have potential for use in tumour stratification and prognostication and as therapeutic targets for treatment of neuroendocrine cancers, following validation with additional samples.
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Yang Z, Zhang D, Shi G. Reappraisal of a 2-cm Cutoff Size for the Management of Nonfunctional Pancreatic Neuroendocrine Tumors: A Population-Based Study. Front Endocrinol (Lausanne) 2022; 13:928341. [PMID: 35923628 PMCID: PMC9339804 DOI: 10.3389/fendo.2022.928341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/31/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Expectant observation and aggressive surgery are both recommended for small nonfunctional pancreatic neuroendocrine tumors (NF-PanNETs). However, the optimal management of small NF-PanNETs remains disputable due to the heterogeneous clinical behavior. METHODS Patients who were diagnosed with pancreatic neuroendocrine neoplasms (PanNENs) between 2000 and 2018 were identified from the surveillance, epidemiology, and end results (SEER) database and reviewed retrospectively. Tumor aggressiveness was defined as poor differentiation, lymph node involvement, liver involvement, and advanced stage. The best cutoff of tumor size associated with tumor aggressiveness was determined through the receiver operating characteristic (ROC) curve analysis. Univariate and multivariate analyses were used to identify prognostic factors in patients with tumors of ≤2 cm. RESULTS A total of 5,172 patients with PanNENs were enrolled, including 1,760 (34.0%) tumors ≤2 cm and 3,412 (66.0%) tumors >2 cm. A 2.5-cm cutoff size was found to be associated with a satisfactory ability in predicting tumor aggressiveness. On multivariate analysis, age, gender, ethnicity, tumor grade, tumor number, and stage were independent prognostic factors for overall survival (OS) in patients with tumors less than or equal to 2 cm in size. A total of 1,621 patients were diagnosed with NF-PanNETs according to the WHO classification, of whom 1,350 underwent surgery, 271 performed active observation. The OS was significantly better in the surgery group compared to the observation group regardless of propensity score analysis. Additionally, a total of 407 patients were selected based on the multivariate Cox regression analysis, of whom 46 underwent observation, 361 underwent surgery, and the OS was comparable. CONCLUSION Expectant observation may be a reasonable alternative to aggressive surgical resection in highly selected small NF-PanNET patients. Also, the decision to observe versus surgery should not only be based on tumor size alone but also take into account other important clinicopathological factors.
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Shi YJ, Li XT, Zhang XY, Zhu HT, Liu YL, Wei YY, Sun YS. Non-gaussian models of 3-Tesla diffusion-weighted MRI for the differentiation of pancreatic ductal adenocarcinomas from neuroendocrine tumors and solid pseudopapillary neoplasms. Magn Reson Imaging 2021; 83:68-76. [PMID: 34314825 DOI: 10.1016/j.mri.2021.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/23/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the MRI performance in differentiating pancreatic ductal adenocarcinomas (PDACs), from solid pseudopapillary neoplasms (SPNs) and pancreatic neuroendocrine tumors (PNETs) using non-gaussian diffusion-weighted imaging models. METHODS This was a retrospective study of patients diagnosed with PDACs (01/2015-06/2019) or with PNETs or SPNs diagnosed (01/2011-12/2019) at our hospital. The lesions were randomized 1:1 to the primary and validation cohorts. The regions of interest (ROIs) were manually drawn on each slice at DWI (b = 1500 s/mm2) from 3 T MRI. D (diffusion coefficient), D* (pseudodiffusion coefficient), f (perfusion fraction), distributed diffusion coefficient (DDC), α (diffusion heterogeneity index), mean diffusivity (MD) and mean kurtosis (MK) were obtained. The parameters with largest performance for differentiation were used to establish a diagnostic model. RESULTS There were 148, 56, and 60 patients with PDAC, PNET, and SPN, respectively. For differentiating PDACs from SPNs, f and MK values were used to establish a diagnostic model with areas under the receiver operating characteristic curves (AUCs) of 0.92 and 0.89 in the primary and validation groups, respectively. For distinguishing PDACs from PNETs, α and MK values were used to establish a diagnostic model with AUCs of 0.87 and 0.86 in the primary and validation groups, respectively. The accuracy rate of the subjective evaluation with the assistance of non-gaussian DWI models for differentiating PDAC from SPNs and PNETs were higher than that of subjective diagnosis alone (P < 0.05). CONCLUSIONS The non-gaussian DWI models could assist radiologists in accurately differentiating PDACs from PNETs and SPNs.
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Affiliation(s)
- Yan-Jie Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Hai-Tao Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Yu-Liang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Yi-Yuan Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing 100142, China.
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Yang Z, Gao H, Lu J, Niu Z, Zhu H, Zong Y, Song X, Yang F, Zhou X. Comparison of clinical outcomes between enucleation and regular pancreatectomy in patients with non-functional pancreatic neuroendocrine tumors: a retrospective multicenter and propensity score-matched study. Jpn J Clin Oncol 2021; 51:595-603. [PMID: 33395471 DOI: 10.1093/jjco/hyaa246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE There are limited data from retrospective studies on whether therapeutic outcomes after regular pancreatectomy are superior to those after enucleation in patients with small, peripheral and well-differentiated non-functional pancreatic neuroendocrine tumors. This study aimed to compare the short- and long-term outcomes of regular pancreatectomy and enucleation in patients with non-functional pancreatic neuroendocrine tumors. METHODS Between January 2007 and July 2020, 227 patients with non-functional pancreatic neuroendocrine tumors who underwent either enucleation (n = 89) or regular pancreatectomy (n = 138) were included. Perioperative complications, disease-free survival, and overall survival probabilities were compared. Propensity score matching was performed to balance the baseline differences between the two groups. RESULTS The median follow-up period was 60.76 months in the enucleation group and 43.29 months in the regular pancreatectomy group. In total, 34 paired patients were identified after propensity score matching. The average operative duration in the enucleation group was significantly shorter than that in the regular pancreatectomy group (147.94 ± 42.39 min versus 217.94 ± 74.60 min, P < 0.001), and the estimated blood loss was also significantly lesser (P < 0.001). The matched patients who underwent enucleation displayed a similar overall incidence of postoperative complications (P = 0.765), and a comparable length of hospital stay (11.12 ± 3.90 days versus 9.94 ± 2.62 days, P = 0.084) compared with those who underwent regular pancreatectomy. There were no statistically significant differences between the two groups in disease-free survival and overall survival after propensity score matching. CONCLUSION Enucleation in patients with non-functional pancreatic neuroendocrine tumors was associated with shorter operative time, lesser intraoperative bleeding, similar overall morbidity of postoperative complications, and comparable 5-year disease-free survival and overall survival when compared with regular pancreatectomy.
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Affiliation(s)
- Zhen Yang
- Department of Hepatopancreatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, 250021, P.R. China
| | - Hengjun Gao
- Department of Hepatopancreatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, 250021, P.R. China
| | - Jun Lu
- Department of Hepatopancreatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, 250021, P.R. China
| | - Zheyu Niu
- Department of Hepatopancreatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, 250021, P.R. China
| | - Huaqiang Zhu
- Department of Hepatopancreatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, 250021, P.R. China
| | - Yuanyuan Zong
- Department of Hepatopancreatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, 250021, P.R. China
| | - Xie Song
- Department of Hepatopancreatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, 250021, P.R. China
| | - Faji Yang
- Department of Hepatopancreatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, 250021, P.R. China
| | - Xu Zhou
- Department of Hepatopancreatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, 250021, P.R. China
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Dong DH, Zhang XF, Lopez-Aguiar AG, Poultsides G, Rocha F, Weber S, Fields R, Idrees K, Cho C, Maithel SK, Pawlik TM. Recurrence of Non-functional Pancreatic Neuroendocrine Tumors After Curative Resection: A Tumor Burden-Based Prediction Model. World J Surg 2021; 45:2134-2141. [PMID: 33768309 DOI: 10.1007/s00268-021-06020-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 10/21/2022]
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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Affiliation(s)
- Ding-Hui Dong
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Alexandra G Lopez-Aguiar
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Flavio Rocha
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Sharon Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ryan Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, WI, USA
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Cliff Cho
- Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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Surgical treatment of non-functioning pancreatic neuroendocrine tumors: current controversies and challenges. JOURNAL OF PANCREATOLOGY 2020. [DOI: 10.1097/jp9.0000000000000047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Abstract
Solid tumors of the pancreas encompass a variety of diagnoses with treatments ranging from observation to major abdominal surgery. Pancreatic ductal adenocarcinoma remains one of the most common and most lethal of these differential of diagnoses and requires a multimodality approach through a multidisciplinary team of specialists. This article reviews the classification, clinical presentation, and workup in differentiating solid tumors of the pancreas and serves as an additional tool for general surgeons faced with such a clinical finding, from a surgical oncology perspective.
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Affiliation(s)
- George Younan
- Department of Surgery, Inova Fair Oaks Hospital, Fairfax, VA, USA; Division of Hepato-Pancreato-Biliary Surgery, Virginia Surgery Associates, 13135 Lee Jackson Memorial Highway, Suite #305, Fairfax, VA 22033, USA.
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Weilin M, Xu H, Yang L, Wenqi C, Huanyu W, Wentao Z, Dayong J, Wenchuan W, Dansong W, Tiantao K, Lei Z, Wenhui L, Xuefeng X. Propensity score-matched analysis of clinical outcome after enucleation versus regular pancreatectomy in patients with small non-functional pancreatic neuroendocrine tumors. Pancreatology 2020; 20:169-176. [PMID: 31941586 DOI: 10.1016/j.pan.2019.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/19/2019] [Accepted: 12/11/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The effectiveness of enucleation in treatment for low-grade (G1, G2) small (≤2 cm) non-functional pancreatic neuroendocrine tumors (sNF-pNETs) remains controversial. This study investigated short- and long-term outcome of enucleation comparing with regular pancreatectomy in patients with sNF-pNETs. METHODS The clinical data of patients with sNF-pNETs who underwent surgery in our hospital from January 2000 to December 2017 were retrospectively collected. Short- and long-term outcomes of two operations were analyzed. The propensity score matching (PSM) was performed to reduce potential selection bias. RESULTS A total of 123 patients with sNF-pNETs were enrolled with 62 males, 69 G1, and median age was 56.91 ± 10.04 years old. During the follow-up period (mean 87 ± 58.1 months), 9(7.32%) disease progressed (recurrence or metastasis) and 2 died (1.62%), 5-years OS was 100%, 5-years DFS was 91.4%. Both lymph node metastasis (p = 0.117) and pathological grade (p = 0.050) were not prognostic factors for sNF-pNETs. The propensity score-matched cohort comprised 27 patients with enucleation and 44 patients with regular pancreatectomy. Enucleation was noninferior to regular pancreatectomy in terms of DFS, before or after PSM. The surgical duration (P < 0.01) and blood loss (P < 0.01) significantly decreased in enucleation compared with regular pancreatectomy. The other postoperative complications tended to occur in regular pancreatectomy than in enucleation, but no statistically significant difference (all p > 0.05). CONCLUSION Enucleation seems to be an effective option for the treatment of sNF-pNETs with a lower total rate of postoperative complications and similar long-term prognosis, compared with regular pancreatectomy.
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Affiliation(s)
- Mao Weilin
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Han Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lv Yang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen Wenqi
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang Huanyu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhou Wentao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jin Dayong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wu Wenchuan
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang Dansong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kuang Tiantao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhang Lei
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lou Wenhui
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Xu Xuefeng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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Pancreatic neuroendocrine tumor, lymphoma, and squamous cell carcinoma of hypopharynx; A case report of three primary cancers in one patient. Int J Surg Case Rep 2019; 65:111-114. [PMID: 31704660 PMCID: PMC6920292 DOI: 10.1016/j.ijscr.2019.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/02/2022] Open
Abstract
We presented a patient with PNET, lymphoma, and SCC occurring simultaneously. Malignant lymphoma in this case presented with a slow-growing mass at right testis. Hypodense lesion at tail of pancreas by CT scan is rather found in adenocarcinoma.
Background Pancreatic neuroendocrine tumors (PNETs) are rarely found and the majority of PNETs are nonfunctioning. At present, a patient with pancreatic neuroendocrine tumor (PNET), lymphoma, and squamous cell carcinoma (SCC) occurring simultaneously has not been reported. We presented all these three primary cancers in a same patient. Case presentation A 51-year-old male presented with a right testicular mass for four months. He underwent right orchidectomy, and the patient was diagnosed malignant diffuse large B-cell lymphoma. Consequently, CHOP regimen and intrathecal methotrexate were given as treatment. During the metastasis work up, a hypodense lesion at the tail of pancreas was found. Distal pancreatectomy and splenectomy were completed, and the pathological report revealed PNET. Eighteen months later, the patient developed a symptom of odynophagia, direct laryngoscopy was performed and a mass at the left arytenoid was found. The biopsy was done and confirmed the diagnosis of SCC. The patient went through concurrent chemo-radiation with a complete response. Currently the patient remains in a complete remission of all three cancers. Discussion As the patient had non-functioning PNET and was symptom-free, the diagnosis would have not been discovered without the metastasis workup of lymphoma. Although non-functioning PNET less than 2 cm can be safely observed, the tumor was 4.3 × 1.3 cm and adenocarcinoma was suspected, so the patient underwent the surgery. Conclusion Although many cases with multiple primary cancers have been published, a case of patient with PNET, lymphoma, and SCC occurring as primary cancers has not been yet reported.
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12
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Buicko JL, Finnerty BM, Zhang T, Kim BJ, Fahey TJ, Nancy Du YC. Insights into the biology and treatment strategies of pancreatic neuroendocrine tumors. ACTA ACUST UNITED AC 2019; 2. [PMID: 31535089 DOI: 10.21037/apc.2019.06.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pancreatic neuroendocrine tumors (PNETs) are the second most common primary pancreatic neoplasms after pancreatic ductal adenocarcinoma. PNETs present with widely various clinical manifestation and unfavorable survival rate. The recent advances in next generation sequencing have significantly increased our understanding of the molecular landscape of PNETs and help guide the development of targeted therapies. This review intends to outline a holistic picture of the tumors by discussing current understanding of clinical presentations, up-to-date treatment strategies, novel mouse models, and molecular biology of PNETs. Furthermore, we will provide insight into the future development of more effective targeted therapies that are necessary to manage PNETs.
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Affiliation(s)
- Jessica L Buicko
- Department of Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | | | - Tiantian Zhang
- Department of Pathology & Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Bu Jung Kim
- Department of Pathology & Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Yi-Chieh Nancy Du
- Department of Pathology & Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA
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13
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Natural History and Treatment Trends in Pancreatic Cancer Subtypes. J Gastrointest Surg 2019; 23:768-778. [PMID: 30706376 DOI: 10.1007/s11605-019-04113-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/07/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND While pancreatic ductal adenocarcinoma is the most common form of pancreatic cancer, many other histologic forms of pancreatic cancer are also recognized. These histologic variants portray unique characteristics in terms of patient demographics, tumor behavior, survival, and responsiveness to treatments. MATERIALS AND METHODS Patients who underwent surgical resection of the pancreas for non-metastatic, invasive pancreatic cancer between 2004 and 2014 were selected from the National Cancer Data Base and categorized by histologic variant according to WHO classification guidelines. Patient demographics, tumor variables, treatment characteristics, and survival were compared between histologic groups and subgroups. RESULTS A total of 57,804 patients met inclusion and exclusion criteria and were grouped into eight major histologic categories. Survival analysis by the histologic group showed median overall survival of 20.2 months for ductal adenocarcinoma, 20.5 months for squamous cell carcinoma, 26.8 months for mixed acinar-neuroendocrine carcinomas, 52.6 months for cystic mucinous neoplasms with an associated invasive carcinoma, 67.5 months for acinar cell carcinoma, and 69.3 months for mesenchymal tumors. Median survival was not reached for neuroendocrine tumors and solid-pseudopapillary neoplasms, with 5-year overall survival rates of 84% and 97% respectively. CONCLUSIONS Rare subtypes of pancreatic cancer present unique clinicopathologic characteristics and display distinct tumor biologies. This study presents data on demographic, prognostic, treatment, and survival outcomes between rare forms of pancreatic neoplasms in order to aid understanding of the natural history and behavior of these neoplasms, with the hope of serving as a reference in clinical decision-making and ability to provide accurate prognostic information to patients.
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Li J, Liang L, Yu H, Shen Y, Hu Y, Hu D, Tang H, Li Z. Whole-tumor histogram analysis of non-Gaussian distribution DWI parameters to differentiation of pancreatic neuroendocrine tumors from pancreatic ductal adenocarcinomas. Magn Reson Imaging 2019; 55:52-59. [PMID: 30240758 DOI: 10.1016/j.mri.2018.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/11/2018] [Accepted: 09/16/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the utility of volumetric histogram analysis of monoexponential and non-Gaussian distribution DWI models for discriminating pancreatic ductal adenocarcinoma (PDAC) and neuroendocrine tumor (pNET). MATERIALS AND METHODS A total of 340 patients were retrospectively reviewed. Finally, 62 patients with histopathological confirmed PDAC (n = 42) and pNET (n = 20) were enrolled in the study. All the patients accepted magnetic resonance imaging (MRI) at 3 T (including multi-b value DWI, 0-1000 s/mm2). Isotropic apparent diffusion coefficient (ADC), true molecular diffusion (Dt), perfusion-related diffusion (Dp), perfusion fraction (f), distributed diffusion coefficient (DDC) and alpha (α) were obtained from different DWI models. Then, mean value, median value, 10th and 90th percentiles were obtained from histogram analysis of each DWI parameter. RESULTS Histogram metrics derived from ADC, Dp, f and DDC were significantly lower in PDAC than pNET group (P < 0.05). In contrast, histogram metrics derived from α were observed significantly higher in the PDAC than pNET group (P < 0.05). No significant difference was found in Dt (P ≥ 0.05) between PDAC and pNET patients. Among all parameters, f-median had the highest diagnostic performance (AUC 0.91, cutoff value 0.188, sensitivity 97.62%, specificity 80%). CONCLUSIONS f-Median derived from IVIM DWI model may be potentially more valuable parameter than ADC, Dp, DDC and α for discriminating PDAC and pNET. Histogram analysis based on the entire tumor was an emerging and valuable tool.
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Affiliation(s)
- Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lili Liang
- Department of Radiology, The first affiliated hospital of Nanyang Medical College, China
| | - Hao Yu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Chawla A, Williams RT, Sich N, Clancy T, Wang J, Ashley S, Pezzi C, Swanson R. Pancreaticoduodenectomy and metastasectomy for metastatic pancreatic neuroendocrine tumors. J Surg Oncol 2018; 118:983-990. [DOI: 10.1002/jso.25219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/02/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Akhil Chawla
- Department of Surgery; Brigham and Women’s Hospital; Boston Massachusetts
| | - Richelle T. Williams
- Department of Surgery; University of Maryland Medical Center; Baltimore Maryland
| | - Nicholas Sich
- Department of Surgery; Abington-Jefferson Health; Abington Pennsylvania
| | - Thomas Clancy
- Department of Surgery; Brigham and Women’s Hospital; Boston Massachusetts
| | - Jiping Wang
- Department of Surgery; Brigham and Women’s Hospital; Boston Massachusetts
| | - Stanley Ashley
- Department of Surgery; Brigham and Women’s Hospital; Boston Massachusetts
| | - Christopher Pezzi
- Department of Surgery; Baptist MD Anderson Cancer Center; Jacksonville Florida
| | - Richard Swanson
- Department of Surgery; Cambridge Health Alliance; Cambridge Massachusetts
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Li J, Lu J, Liang P, Li A, Hu Y, Shen Y, Hu D, Li Z. Differentiation of atypical pancreatic neuroendocrine tumors from pancreatic ductal adenocarcinomas: Using whole-tumor CT texture analysis as quantitative biomarkers. Cancer Med 2018; 7:4924-4931. [PMID: 30151864 PMCID: PMC6198241 DOI: 10.1002/cam4.1746] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background To explore the application value of computed tomography (CT) texture analysis in differentiating atypical pancreatic neuroendocrine tumors (pNET) from pancreatic ductal adenocarcinomas (PDAC). Materials and methods This single‐center retrospective study was approved by local institutional review board, and the requirement for informed consent was waived. We retrospectively analyzed 127 patients with 50 PDACs and 77 pNETs in pathology database between January 2012 and May 2017.These patients successfully finished preoperative contrast‐enhanced CT test. Texture parameters (mean, median, 5th, 10th, 25th, 75th, 90th percentiles, skewness, kurtosis and entropy) were extracted from portal images and compared between PDAC and 77 pNET groups using proper statistical method. The optimal parameters for differentiating PDACs and atypical pNETs were gained through receiver operating characteristic (ROC) curves. Results On the basis of arterial enhancement, 52 pNETs (67%, 52/77) were typical hypervascular and 25 pNETs (32%, 25/77) were atypical hypovascular. Compared with PDACs, atypical pNETs had statistically higher mean, median, 5th, 10th, and 25th percentiles (P = 0.006, 0.024, 0.000, 0.001, 0.021, respectively) and statistically lower skewness (P = 0.017). However, there were no difference for 75th, 90th percentiles, kurtosis and entropy between these two tumors (P = 0.232, 0.415, 0.143, 0.291, respectively). For differentiating PDACs and atypical pNETs, 5th percentile and 5th+skewness were optimal parameters for alone and combined diagnosis, respectively. Conclusion Volumetric CT texture features, especially combined diagnosis of 5th+skewness can be used as a quantitative tool to distinguish atypical pNETs from PDACs.
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Affiliation(s)
- Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyu Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Anqin Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Karmazanovsky G, Belousova E, Schima W, Glotov A, Kalinin D, Kriger A. Nonhypervascular pancreatic neuroendocrine tumors: Spectrum of MDCT imaging findings and differentiation from pancreatic ductal adenocarcinoma. Eur J Radiol 2018; 110:66-73. [PMID: 30599875 DOI: 10.1016/j.ejrad.2018.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/08/2018] [Accepted: 04/05/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of our study was to determine contrast-enhanced MDCT features to differentiate nonhypervascular pancreatic neuroendocrine tumors (PNETs) from pancreatic ductal adenocarcinomas (PDACs). METHODS and materials: We included 74 patients with PNETs and 80 patients with PDACs who underwent preoperative MDCT. Two radiologists evaluated the morphologic characteristic and enhancement patterns of the tumors. Quantitative and qualitative analysis was performed, including evaluation of tumor size, homogeneity, contrast enhancement pattern, presence of pancreatic duct dilatation and tumor invasion to the adjacent vessels and peripancreatic infiltration. Tumor-to-pancreas enhancement ratio was defined as the Hounsfield units (HU) value of the tumor divided by the HU value of the pancreas. the first group was hypervascular PNETs showing hyperenhancement on arterial phase images and nonhypervascular PNETs, showing iso- or hypoenhancement on arterial phase images. After that, two radiologists estimated the possibilities of PNET or PDAC were for nonhypervascular PNETs. RESULTS On the basis of arterial enhancement, 43 PNETs were hypervascular and 31 were nonhypervascular. When compared to PDAC, nonhypervascular PNETs more frequently had well-defined tumor margins, intratumoral cystic components, calcifications and blood vessels and less frequently had main pancreatic duct dilatation, peripancreatic infiltration and vascular invasion (p < 0.01 for all). Nonhypervascular PNETs had higher tumor-to-pancreas enhancement ratio in venous phase (1.02 vs. 0.78, p = 0.012). Nonhypervascular PNETs more often had portal-venous hyperenhancement or persistent isoenhancement, while PDAC more often had persistent hypoenhancement or gradual delayed enhancement (p < 0.001). The absence of pancreatic duct dilatation and portal-venous hyperenhancement or persistent isoenhancement were the independent predictors for nonhypervascular PNETs. (The most accurate MDCT-findings to predict nonhypervascular PNET were the absence of pancreatic duct dilatation and peripancreatic infiltration (79% and 92% accuracy), portal-venous phase hyperenhancement or persistent isoenhancement (77%), the presence of intratumoral blood vessels (77%) and relative enhancement intensity in venous phase >0.9 (76%). Using these criteria, the area under curve for differentiation of PNET from PDAC was 0.906-0.846. CONCLUSION Combined assessment of the enhancement and morphologic characteristics can improve the differentiation between nonhypervascular PNETs and PDAC at contrast-enhanced MDCT.
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Affiliation(s)
- Grigory Karmazanovsky
- Department of Radiology, A.V. Vishnevsky Institute of Surgery, Moscow, Russia; Department of Radiology, Faculty of Postgraduate Professional Training of Physicians, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Elena Belousova
- Department of Radiology, A.V. Vishnevsky Institute of Surgery, Moscow, Russia; Department of Radiology, Faculty of Postgraduate Professional Training of Physicians, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Wolfgang Schima
- Department of Diagnostic and Interventional Radiology, Goettlicher Heiland Krankenhaus, Barmherzige Schwestern Krankenhaus, and Sankt Josef Krankenhaus, Vinzenzgruppe, Vienna, Austria
| | - Andrei Glotov
- Department of Pathology, A.V. Vishnevsky Institute of Surgery, Moscow, Russia
| | - Dmitry Kalinin
- Department of Pathology, A.V. Vishnevsky Institute of Surgery, Moscow, Russia
| | - Andrei Kriger
- Department of Abdominal Surgery, A.V. Vishnevsky Institute of Surgery, Moscow, Russia
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Finkelstein P, Sharma R, Picado O, Gadde R, Stuart H, Ripat C, Livingstone AS, Sleeman D, Merchant N, Yakoub D. Pancreatic Neuroendocrine Tumors (panNETs): Analysis of Overall Survival of Nonsurgical Management Versus Surgical Resection. J Gastrointest Surg 2017; 21:855-866. [PMID: 28255853 DOI: 10.1007/s11605-017-3365-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 01/05/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes of patients with pancreatic neuroendocrine tumors (panNETs) undergoing surgical or nonsurgical management and outcomes of enucleation versus standard resection were compared. METHODS MEDLINE, EMBASE, PubMed, Scopus, and Cochrane were queried (2000 to present). All studies comparing patients undergoing surgical versus nonsurgical treatments, or enucleation versus standard resection, were included. Pooled risk ratios and 95% CI for survival were calculated. RESULTS Eleven studies met criteria with 1491 resected and 1607 nonsurgically managed patients. Meta-analysis showed improved overall survival with resection at 1 year (risk ratio (RR) = 1.281, CI 1.064-1.542, p = 0.009), 3 years (RR = 1.837, CI 1.594-2.117, p < 0.001), and 5 years (RR = 2.103, CI 1.50-2.945, p < 0.001). OS of patients with resected nonfunctioning panNETs was improved at 3 years (RR = 1.847, CI 1.477-2.309, p < 0.001) and 5 years (RR = 1.767, CI 1.068-2.924, p = 0.027). OS was improved when panNETs ≤2 cm were resected at 3 years (RR = 1.695, CI 1.269-2.264, p < 0.001) and 5 years (RR = 2.210, CI 1.749-2.791, p < 0.001). Fifteen articles met criteria for enucleation versus standard resection (n = 1035; 620 were nonfunctioning). Enucleation had shorter operative time (weighted mean difference (WMD) = -95.6 min, 95% CI -131.4 to -59.8, p < 0.01), less operative blood loss (WMD = -172.6 ml, 95% CI -340 to -5.1, p = 0.04), but increased postoperative pancreatic fistula (POPF) (RR = 2.08, 95% CI 1.39-3.12, p < 0.01). CONCLUSION Surgical resection of panNETs, including small and nonfunctioning, appears to be associated with improved OS. Enucleation is associated with shorter operative time, less blood loss, but greater incidence of POPF. Prospective, randomized clinical trials are needed to confirm these results.
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Affiliation(s)
- Paige Finkelstein
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Rishika Sharma
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Omar Picado
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Rahul Gadde
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Heather Stuart
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Caroline Ripat
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Alan S Livingstone
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Danny Sleeman
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Nipun Merchant
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Danny Yakoub
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
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Abstract
Pancreatic neuroendocrine neoplasms (pNENs) are a heterogeneous group of tumors including well differentiated pancreatic neuroendocrine tumors (pNETs) and neuroendocrine carcinomas (pNECs). The incidence of pNENs has increased over the past few decades. Although, the understanding and interest for this tumor have also increased significantly, the debate about classification and diagnosis continues. Although the primary treatment for pNENs is surgical resection, there is still a lack of effective therapeutic options for patients with advanced unresectable pNENs. Although many therapeutic methods have proven effective, the choice of treatment and specific programs are still unclear. Our article presents an overview of pNENs, with a focus on their diagnostic work-up, clinical presentation and treatment options.
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Affiliation(s)
- Jian Sun
- Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Address correspondence to: Dr. Jian Sun, Department of Biliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiangxi Road, Guangzhou 510120, China. E-mail:
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Cienfuegos JA, Salguero J, Núñez-Córdoba JM, Ruiz-Canela M, Benito A, Ocaña S, Zozaya G, Martí-Cruchaga P, Pardo F, Hernández-Lizoáin JL, Rotellar F. Short- and long-term outcomes of laparoscopic organ-sparing resection in pancreatic neuroendocrine tumors: a single-center experience. Surg Endosc 2017; 31:3847-3857. [DOI: 10.1007/s00464-016-5411-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/30/2016] [Indexed: 02/06/2023]
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Abstract
Pancreatic neuroendocrine tumors (PNETs) are a rare, heterogeneous group of neoplasms infamous for their endocrinopathies. Up to 90% of PNETs, however, are nonfunctional and are frequently detected incidentally on axial imaging during the evaluation of vague abdominal symptoms. Surgery remains the mainstay of therapy for patients diagnosed with both functional and nonfunctional PNETs. However, the multifaceted nature of PNETs challenges treatment decision making. In general, resection is recommended for patients with acceptable perioperative risk and amenable lesions.
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Affiliation(s)
- Jason B Liu
- Department of Surgery, University of Chicago Hospitals, Chicago, IL, USA
| | - Marshall S Baker
- Department of Surgery, University of Chicago Hospitals, Chicago, IL, USA; Division of Surgical Oncology, Department of Surgery, NorthShore University Health System, Evanston, IL, USA.
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Jeon SK, Lee JM, Joo I, Lee ES, Park HJ, Jang JY, Ryu JK, Lee KB, Han JK. Nonhypervascular Pancreatic Neuroendocrine Tumors: Differential Diagnosis from Pancreatic Ductal Adenocarcinomas at MR Imaging-Retrospective Cross-sectional Study. Radiology 2017; 284:77-87. [PMID: 28092495 DOI: 10.1148/radiol.2016160586] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To determine useful magnetic resonance (MR) imaging features to differentiate nonhypervascular pancreatic neuroendocrine tumors (PNETs) from pancreatic ductal adenocarcinomas (PDACs). Materials and Methods The institutional review board approved this retrospective study and waived the informed consent requirement. Seventy-four patients with surgically confirmed PNETs and 82 patients with PDACs who underwent gadobutrol-enhanced MR imaging were included. Two radiologists independently evaluated the morphologic characteristics and temporal enhancement patterns of each tumor. Quantitative analysis, including measurement of tumor size, maximal upstream parenchymal thickness (MUPT), contrast-to-noise ratio, and apparent diffusion coefficient values, was performed. Uni- and multivariate logistic regression analyses were performed to identify relevant features to differentiate between PNETs and PDACs. Results On the basis of arterial enhancement, 38 PNETs (51%, 38 of 74) were hypervascular and 36 PNETs (49%, 36 of 74) were nonhypervascular. At MR imaging, nonhypervascular PNETs showed significantly higher frequencies of a well-defined margin, portal hyper- or isoenhancement, and MUPT of 10 mm or greater but lower frequencies of ductal dilatation, vascular invasion, and peripancreatic infiltration when compared with PDACs (P < .05 for all). At multivariate analysis, a well-defined margin and portal hyper- or isoenhancement were independent significant differentiators of PNETs from PDACs (odds ratio, 20.3 and 16.1, respectively). When applying the criteria of a well-defined margin and portal hyper- or isoenhancement, 64% of sensitivity and 99% of specificity were observed for the differential diagnosis of PNETs from PDACs. Conclusion A well-defined margin and hyper- or isoenhancement in the portal venous phase are useful MR imaging features that are more common in nonhypervascular PNETs and may help discriminate nonhypervascular PNETs from PDACs. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Sun Kyung Jeon
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Jeong Min Lee
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Ijin Joo
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Eun Sun Lee
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Hyun Jeong Park
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Jin-Young Jang
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Ji Kon Ryu
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Kyung Bun Lee
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Joon Koo Han
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
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Surgery management for sporadic small (≤2 cm), non-functioning pancreatic neuroendocrine tumors: A consensus statement by the Chinese Study Group for Neuroendocrine Tumors (CSNET). Int J Oncol 2016; 50:567-574. [PMID: 28035372 DOI: 10.3892/ijo.2016.3826] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/12/2016] [Indexed: 11/05/2022] Open
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Keutgen XM, Babic B, Nilubol N. Management of pancreatic neuroendocrine tumors. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016. [DOI: 10.2217/ije-2016-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pancreatic neuroendocrine tumors (pNETs) are rare tumors that have a better prognosis than their exocrine counterpart, but frequently present with advanced disease. Management of pNETs has evolved considerably over the past decade. Surgical resection remains the only potentially curative option for patients with pNETs. Patients who have locoregionally advanced and/or metastatic pNETs require additional treatments. These include liver-directed (transarterial (chemo)-embolization, selective intraarterial radio therapy) and systemic therapies (somatostatin analogs, targeted therapy such as tyrosine-kinase inhibitors and mammalian target of rapamycin inhibitor, peptide receptor radionuclide therapy and cytotoxic chemotherapy). The aim of this article is to review the current treatment options as well as potential future therapeutic perspectives for patients with pNETs.
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Affiliation(s)
- Xavier M Keutgen
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bruna Babic
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Naris Nilubol
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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