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Sugawara T, Rodriguez Franco S, Franklin O, Kirsch MJ, Colborn KL, Del Chiaro M, Schulick RD. Management of Localized Small- and Large-Cell Pancreatic Neuroendocrine Carcinoma in the National Cancer Database. J Am Coll Surg 2023; 237:515-524. [PMID: 37146214 DOI: 10.1097/xcs.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND The role of curative-intent resection and perioperative chemotherapy for nonmetastatic pancreatic neuroendocrine carcinoma (PanNEC) remains unclear due to their biological aggressiveness and rarity. This study aimed to evaluate the association of resection and perioperative chemotherapy with overall survival for nonmetastatic PanNEC. STUDY DESIGN Patients with localized (cT1-3, M0), small- and large-cell PanNEC were identified in the National Cancer Database from 2004 to 2017. The changing trends in terms of the annual proportions of resection and adjuvant chemotherapy were assessed. The survival of patients who received resection and those who received adjuvant chemotherapy were investigated using Kaplan-Meier estimates and Cox regression models. RESULTS In total, 199 patients with localized small- and large-cell PanNEC were identified; 50.3% of those were resected, and 45.0% of the resected patients received adjuvant chemotherapy. Rate of resection and adjuvant treatment has trended upward since 2011. The resected group was younger, was more often treated at academic institutions, had more distal tumors, and had a lower number of small-cell PanNEC. The median overall survival was longer in the resected group compared to the unresected group (29.4 months vs 8.6 months, p < 0.001). Resection was associated with improved survival in a multivariable Cox regression model adjusting for preoperative factors (adjusted hazard ratio 0.58, 95% CI 0.37 to 0.92), while adjuvant therapy was not. CONCLUSIONS This nationwide retrospective study suggests that resection is associated with improved survival in patients with localized PanNEC. The role of adjuvant chemotherapy needs more investigation.
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Affiliation(s)
- Toshitaka Sugawara
- From the Division of Surgical Oncology, Department of Surgery (Sugawara, Rodriguez Franco, Franklin, Colborn, Del Chairo), University of Colorado School of Medicine, Aurora, Colorado
- the Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan (Sugawara)
| | - Salvador Rodriguez Franco
- From the Division of Surgical Oncology, Department of Surgery (Sugawara, Rodriguez Franco, Franklin, Colborn, Del Chairo), University of Colorado School of Medicine, Aurora, Colorado
| | - Oskar Franklin
- From the Division of Surgical Oncology, Department of Surgery (Sugawara, Rodriguez Franco, Franklin, Colborn, Del Chairo), University of Colorado School of Medicine, Aurora, Colorado
- the Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden (Franklin)
| | - Michael J Kirsch
- the Department of Surgery (Kirsch, Schulick), University of Colorado School of Medicine, Aurora, Colorado
| | - Kathryn L Colborn
- From the Division of Surgical Oncology, Department of Surgery (Sugawara, Rodriguez Franco, Franklin, Colborn, Del Chairo), University of Colorado School of Medicine, Aurora, Colorado
- the Department of Biostatistics and Informatics (Colborn), University of Colorado School of Medicine, Aurora, Colorado
- the Surgical Outcomes and Applied Research Program (Colborn), University of Colorado School of Medicine, Aurora, Colorado
| | - Marco Del Chiaro
- From the Division of Surgical Oncology, Department of Surgery (Sugawara, Rodriguez Franco, Franklin, Colborn, Del Chairo), University of Colorado School of Medicine, Aurora, Colorado
- the University of Colorado Cancer Center (Del Chiaro, Schulick), University of Colorado School of Medicine, Aurora, Colorado
| | - Richard D Schulick
- the Department of Surgery (Kirsch, Schulick), University of Colorado School of Medicine, Aurora, Colorado
- the University of Colorado Cancer Center (Del Chiaro, Schulick), University of Colorado School of Medicine, Aurora, Colorado
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