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Perry RR, Feliberti EC, Hughes MS. Management of Pancreatic Neuroendocrine Tumors (PNETs): Surgical strategies and controversies. Endocr Pract 2024:S1530-891X(24)00608-6. [PMID: 39032831 DOI: 10.1016/j.eprac.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/01/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE Pancreatic neuroendocrine tumors (PNETs) are uncommon tumors which are increasing in incidence. The management of these tumors continues to evolve. This review examines the current role of surgery in the treatment of these tumors METHODS: Studies published over the past 10 years were identified using several databases including PubMed, MEDLINE, and Science Direct. Search terms included pancreatic neuroendocrine tumors, treatment, and surgery. Clinical practice guidelines and updates from several major groups were reviewed. RESULTS Surgery continues to have a major role in the treatment of sporadic functional and Felibert non-functional PNETs. Pancreas-sparing approaches are increasingly accepted as alternatives to formal pancreatic resection in selected patients. Options such as watch and wait or endoscopic ablation may be reasonable alternatives to surgery for NF-PNETs < 2cm in size. Surgical decision-making in MEN-1 patients remains complex and in some situations such as gastrinoma quite controversial. The role of surgery has significantly diminished in patients with advanced disease due to the advent of more effective systemic and liver-directed therapies. However, the optimal treatments and sequencing in advanced disease remain poorly defined, and it has been suggested that surgery is underutilized in these patients. CONCLUSIONS Surgery remains a major treatment modality for PNETs. Given the plethora of available treatments, ongoing controversies and the changing landscape, management has become increasingly complex. An experienced multidisciplinary team which includes surgery in essential to manage these patients.
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Affiliation(s)
- Roger R Perry
- From the Division of Surgical Oncology, Eastern Virginia Medical School, Norfolk, VA 23507.
| | - Eric C Feliberti
- From the Division of Surgical Oncology, Eastern Virginia Medical School, Norfolk, VA 23507
| | - Marybeth S Hughes
- From the Division of Surgical Oncology, Eastern Virginia Medical School, Norfolk, VA 23507
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Takikawa T, Kikuta K, Hamada S, Kume K, Miura S, Yoshida N, Tanaka Y, Matsumoto R, Ikeda M, Kataoka F, Sasaki A, Hayashi H, Hatta W, Ogata Y, Nakagawa K, Unno M, Masamune A. A New Preoperative Scoring System for Predicting Aggressiveness of Non-Functioning Pancreatic Neuroendocrine Neoplasms. Diagnostics (Basel) 2022; 12:diagnostics12020397. [PMID: 35204488 PMCID: PMC8870938 DOI: 10.3390/diagnostics12020397] [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: 12/30/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 12/04/2022] Open
Abstract
The management of non-functioning pancreatic neuroendocrine neoplasms (NF-PanNENs) is still controversial. This study aimed to develop a new scoring system for treatment decisions at initial diagnosis based on the identification of the predictive factors for aggressive NF-PanNENs. Seventy-seven patients who had been pathologically diagnosed with NF-PanNENs were enrolled. We retrospectively reviewed 13 variables that could be assessed preoperatively. Univariate and multivariate stepwise logistic regression analyses were performed to identify factors for the aggressiveness of NF-PanNENs, and a scoring system was developed by assigning weighted points proportional to their β regression coefficient. Tumor size > 20 mm on contrast-enhanced computed tomography, tumor non-vascularity, and Ki-67 labeling index ≥5% on endoscopic ultrasound-guided fine-needle aspiration specimens were identified as independent factors for predicting the aggressiveness of NF-PanNENs. The new scoring system, developed using the identified factors, had an excellent discrimination ability, with area under the curve of 0.92 (95% CI, 0.85–0.99), and good calibration (p = 0.72, Hosmer-Lemeshow test). Ten-year overall survival rates in low-risk (0 point), intermediate-risk (1 to 2 points), and high-risk (3 to 4 points) groups were 100%, 90.9%, and 24.3%, respectively. This new scoring system would be useful for treatment decisions and prognostic prediction at initial diagnosis.
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Affiliation(s)
- Tetsuya Takikawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Shin Hamada
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Shin Miura
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Naoki Yoshida
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Yu Tanaka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Ryotaro Matsumoto
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Mio Ikeda
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Fumiya Kataoka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Akira Sasaki
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Hidehiro Hayashi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Kei Nakagawa
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai 980-8574, Japan; (K.N.); (M.U.)
| | - Michiaki Unno
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai 980-8574, Japan; (K.N.); (M.U.)
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
- Correspondence: ; Tel.:+81-22-717-7171; Fax: +81-22-717-7177
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