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A Preoperative Clinical Risk Score Including C-Reactive Protein Predicts Histological Tumor Characteristics and Patient Survival after Surgery for Sporadic Non-Functional Pancreatic Neuroendocrine Neoplasms: An International Multicenter Cohort Study †

Background: Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) is highly variable depending on various factors. Risk stratification with preoperatively available parameters could guide decision-making in multidisciplinary treatment concepts. C-reactive Protein (CRP)...

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Detalles Bibliográficos
Autores principales: Primavesi, Florian, Andreasi, Valentina, Hoogwater, Frederik J.H., Partelli, Stefano, Wiese, Dominik, Heidsma, Charlotte, Cardini, Benno, Klieser, Eckhard, Marsoner, Katharina, Fröschl, Uwe, Thalhammer, Sabine, Fischer, Ines, Göbel, Georg, Hauer, Andreas, Kiesslich, Tobias, Ellmerer, Philipp, Klug, Reinhold, Neureiter, Daniel, Wundsam, Helwig, Sellner, Franz, Kornprat, Peter, Függer, Reinhold, Öfner, Dietmar, Nieveen van Dijkum, Elisabeth J.M., Bartsch, Detlef K., de Kleine, Ruben H.J., Falconi, Massimo, Stättner, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280962/
https://www.ncbi.nlm.nih.gov/pubmed/32423000
http://dx.doi.org/10.3390/cancers12051235
Descripción
Sumario:Background: Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) is highly variable depending on various factors. Risk stratification with preoperatively available parameters could guide decision-making in multidisciplinary treatment concepts. C-reactive Protein (CRP) is linked to inferior survival in several malignancies. This study assesses CRP within a novel risk score predicting histology and outcome after surgery for sporadic non-functional panNENs. Methods: A retrospective multicenter study with national exploration and international validation. CRP and other factors associated with overall survival (OS) were evaluated by multivariable cox-regression to create a clinical risk score (CRS). Predictive values regarding OS, disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by time-dependent receiver-operating characteristics. Results: Overall, 364 patients were included. Median CRP was significantly higher in patients >60 years, G3, and large tumors. In multivariable analysis, CRP was the strongest preoperative factor for OS in both cohorts. In the combined cohort, CRP (cut-off ≥0.2 mg/dL; hazard-ratio (HR):3.87), metastases (HR:2.80), and primary tumor size ≥3.0 cm (HR:1.83) showed a significant association with OS. A CRS incorporating these variables was associated with postoperative histological grading, T category, nodal positivity, and 90-day morbidity/mortality. Time-dependent area-under-the-curve at 60 months for OS, DSS, and RFS was 69%, 77%, and 67%, respectively (all p < 0.001), and the inclusion of grading further improved the predictive potential (75%, 84%, and 78%, respectively). Conclusions: CRP is a significant marker of unfavorable oncological characteristics in panNENs. The proposed internationally validated CRS predicts histological features and patient survival.