Cargando…

Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study

SIMPLE SUMMARY: Approximately 30% of patients with a pancreatic neuroendocrine tumor (pNET) will develop metastases. Curative-intent treatment largely involves resection. Identifying patients with early recurrence (ER) following resection might help tailor adjuvant therapies and the surveillance int...

Descripción completa

Detalles Bibliográficos
Autores principales: Heidsma, Charlotte M., Tsilimigras, Diamantis I., Rocha, Flavio, Abbott, Daniel E., Fields, Ryan, Poultsides, George A., Cho, Clifford S., Lopez-Aguiar, Alexandra G., Kanji, Zaheer, Fisher, Alexander V., Krasnick, Bradley A., Idrees, Kamran, Makris, Eleftherios, Beems, Megan, van Eijck, Casper H. J., Nieveen van Dijkum, Elisabeth J. M., Maithel, Shishir K., Pawlik, Timothy M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124896/
https://www.ncbi.nlm.nih.gov/pubmed/34067017
http://dx.doi.org/10.3390/cancers13092242
_version_ 1783693342481055744
author Heidsma, Charlotte M.
Tsilimigras, Diamantis I.
Rocha, Flavio
Abbott, Daniel E.
Fields, Ryan
Poultsides, George A.
Cho, Clifford S.
Lopez-Aguiar, Alexandra G.
Kanji, Zaheer
Fisher, Alexander V.
Krasnick, Bradley A.
Idrees, Kamran
Makris, Eleftherios
Beems, Megan
van Eijck, Casper H. J.
Nieveen van Dijkum, Elisabeth J. M.
Maithel, Shishir K.
Pawlik, Timothy M.
author_facet Heidsma, Charlotte M.
Tsilimigras, Diamantis I.
Rocha, Flavio
Abbott, Daniel E.
Fields, Ryan
Poultsides, George A.
Cho, Clifford S.
Lopez-Aguiar, Alexandra G.
Kanji, Zaheer
Fisher, Alexander V.
Krasnick, Bradley A.
Idrees, Kamran
Makris, Eleftherios
Beems, Megan
van Eijck, Casper H. J.
Nieveen van Dijkum, Elisabeth J. M.
Maithel, Shishir K.
Pawlik, Timothy M.
author_sort Heidsma, Charlotte M.
collection PubMed
description SIMPLE SUMMARY: Approximately 30% of patients with a pancreatic neuroendocrine tumor (pNET) will develop metastases. Curative-intent treatment largely involves resection. Identifying patients with early recurrence (ER) following resection might help tailor adjuvant therapies and the surveillance intensity. The aim of this retrospective study was to determine an evidence-based cut-off value for ER, and to explore risk factors associated with ER. ER was identified 18 months after surgery. Tumor size (OR 1.20, 95% CI 1.05–1.37, p = 0.007) and positive lymph nodes (OR 4.69, 95%CI 1.41–15.58, p = 0.01) were independently associated with ER. Patients with ER had lower post-recurrence free survival and overall survival than patients with late recurrence. These data support intensive follow-up shortly after surgery, and adjuvant therapy may help improve survival in pNET patients with ER after surgery. ABSTRACT: Background: Identifying patients at risk for early recurrence (ER) following resection for pancreatic neuroendocrine tumors (pNETs) might help to tailor adjuvant therapies and surveillance intensity in the post-operative setting. Methods: Patients undergoing surgical resection for pNETs between 1998–2018 were identified using a multi-institutional database. Using a minimum p-value approach, optimal cut-off value of recurrence-free survival (RFS) was determined based on the difference in post-recurrence survival (PRS). Risk factors for early recurrence were identified. Results: Among 807 patients who underwent curative-intent resection for pNETs, the optimal length of RFS to define ER was identified at 18 months (lowest p-value of 0.019). Median RFS was 11.0 months (95% 8.5–12.60) among ER patients (n = 49) versus 41.0 months (95% CI: 35.0–45.9) among non-ER patients (n = 77). Median PRS was worse among ER patients compared with non-ER patients (42.6 months vs. 81.5 months, p = 0.04). On multivariable analysis, tumor size (OR: 1.20, 95% CI: 1.05–1.37, p = 0.007) and positive lymph nodes (OR: 4.69, 95% CI: 1.41–15.58, p = 0.01) were independently associated with ER. Conclusion: An evidence-based cut-off value for ER after surgery for pNET was defined at 18 months. These data emphasized the importance of close follow-up in the first two years after surgery.
format Online
Article
Text
id pubmed-8124896
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-81248962021-05-17 Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study Heidsma, Charlotte M. Tsilimigras, Diamantis I. Rocha, Flavio Abbott, Daniel E. Fields, Ryan Poultsides, George A. Cho, Clifford S. Lopez-Aguiar, Alexandra G. Kanji, Zaheer Fisher, Alexander V. Krasnick, Bradley A. Idrees, Kamran Makris, Eleftherios Beems, Megan van Eijck, Casper H. J. Nieveen van Dijkum, Elisabeth J. M. Maithel, Shishir K. Pawlik, Timothy M. Cancers (Basel) Article SIMPLE SUMMARY: Approximately 30% of patients with a pancreatic neuroendocrine tumor (pNET) will develop metastases. Curative-intent treatment largely involves resection. Identifying patients with early recurrence (ER) following resection might help tailor adjuvant therapies and the surveillance intensity. The aim of this retrospective study was to determine an evidence-based cut-off value for ER, and to explore risk factors associated with ER. ER was identified 18 months after surgery. Tumor size (OR 1.20, 95% CI 1.05–1.37, p = 0.007) and positive lymph nodes (OR 4.69, 95%CI 1.41–15.58, p = 0.01) were independently associated with ER. Patients with ER had lower post-recurrence free survival and overall survival than patients with late recurrence. These data support intensive follow-up shortly after surgery, and adjuvant therapy may help improve survival in pNET patients with ER after surgery. ABSTRACT: Background: Identifying patients at risk for early recurrence (ER) following resection for pancreatic neuroendocrine tumors (pNETs) might help to tailor adjuvant therapies and surveillance intensity in the post-operative setting. Methods: Patients undergoing surgical resection for pNETs between 1998–2018 were identified using a multi-institutional database. Using a minimum p-value approach, optimal cut-off value of recurrence-free survival (RFS) was determined based on the difference in post-recurrence survival (PRS). Risk factors for early recurrence were identified. Results: Among 807 patients who underwent curative-intent resection for pNETs, the optimal length of RFS to define ER was identified at 18 months (lowest p-value of 0.019). Median RFS was 11.0 months (95% 8.5–12.60) among ER patients (n = 49) versus 41.0 months (95% CI: 35.0–45.9) among non-ER patients (n = 77). Median PRS was worse among ER patients compared with non-ER patients (42.6 months vs. 81.5 months, p = 0.04). On multivariable analysis, tumor size (OR: 1.20, 95% CI: 1.05–1.37, p = 0.007) and positive lymph nodes (OR: 4.69, 95% CI: 1.41–15.58, p = 0.01) were independently associated with ER. Conclusion: An evidence-based cut-off value for ER after surgery for pNET was defined at 18 months. These data emphasized the importance of close follow-up in the first two years after surgery. MDPI 2021-05-07 /pmc/articles/PMC8124896/ /pubmed/34067017 http://dx.doi.org/10.3390/cancers13092242 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Heidsma, Charlotte M.
Tsilimigras, Diamantis I.
Rocha, Flavio
Abbott, Daniel E.
Fields, Ryan
Poultsides, George A.
Cho, Clifford S.
Lopez-Aguiar, Alexandra G.
Kanji, Zaheer
Fisher, Alexander V.
Krasnick, Bradley A.
Idrees, Kamran
Makris, Eleftherios
Beems, Megan
van Eijck, Casper H. J.
Nieveen van Dijkum, Elisabeth J. M.
Maithel, Shishir K.
Pawlik, Timothy M.
Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study
title Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study
title_full Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study
title_fullStr Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study
title_full_unstemmed Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study
title_short Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study
title_sort identifying risk factors and patterns for early recurrence of pancreatic neuroendocrine tumors: a multi-institutional study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124896/
https://www.ncbi.nlm.nih.gov/pubmed/34067017
http://dx.doi.org/10.3390/cancers13092242
work_keys_str_mv AT heidsmacharlottem identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT tsilimigrasdiamantisi identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT rochaflavio identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT abbottdaniele identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT fieldsryan identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT poultsidesgeorgea identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT chocliffords identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT lopezaguiaralexandrag identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT kanjizaheer identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT fisheralexanderv identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT krasnickbradleya identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT idreeskamran identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT makriseleftherios identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT beemsmegan identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT vaneijckcasperhj identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT nieveenvandijkumelisabethjm identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT maithelshishirk identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy
AT pawliktimothym identifyingriskfactorsandpatternsforearlyrecurrenceofpancreaticneuroendocrinetumorsamultiinstitutionalstudy