Abstract
Background
To determine treatment strategies corresponding to a wide range of pancreatic neuroendocrine
neoplasms staging, easier-to-use and detailed prognostic classification is required.
Methods
Patients with pancreatic neuroendocrine neoplasms who underwent curative-intent surgery
at the University of Tokyo Hospital between 2000 and 2018 were retrospectively reviewed.
The presence or absence of venous and lymphatic invasion was assessed. Multivariable
analysis was performed to identify the risk factors of shorter overall survival and
recurrence-free survival. Patients were classified into the following 3 groups: a
lymphovascular invasion 0 group, whereby both venous and lymphatic invasion were negative;
an lymphovascular invasion 1 group, where either of the 2 was positive; and an lymphovascular
invasion 2 group, where both were positive. The survival curves and recurrence patterns
of the 3 groups were compared.
Results
Eighty-nine patients were analyzed. Multivariable analysis revealed that lymphatic
invasion and Ki-67 index (≥ 3.0%) were independent prognostic factors of recurrence-free
survival (hazard ratio: 5.2 and 3.6). Fifty-three patients were classified as lymphovascular
invasion 0, 26 as lymphovascular invasion 1, and 10 as lymphovascular invasion 2.
The recurrence-free survival curves of the 3 groups were significantly stratified
(10-year recurrence-free survival: 89.1% in lymphovascular invasion 0, 57.1% in lymphovascular
invasion 1, and 18.3% in lymphovascular invasion 2). Five-year cumulative liver and
lymph node metastasis of lymphovascular invasion 0, lymphovascular invasion 1, and
lymphovascular invasion 2 were well stratified at 0% and 3.8%, 15.8% and 23.1%, and
33.3% and 70.0%, respectively.
Conclusion
Postoperative prognosis of resected pancreatic neuroendocrine neoplasms could be finely
classified by venous invasion and lymphatic invasion. Management after curative-intent
surgery for pancreatic neuroendocrine neoplasms may be changed by this new classification.
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Article info
Publication history
Published online: September 18, 2022
Accepted:
August 4,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary on “Venous Invasion and Lymphatic Invasion are Correlated With The Postoperative Prognosis Of Pancreatic Neuroendocrine Neoplasm.”SurgeryVol. 173Issue 2
- PreviewPancreatic neuroendocrine neoplasms (PNEN) account for <2% of all pancreatic tumors; however, their incidence is increasing due to increasing use of cross-sectional imaging. Most PNENs are small, benign, indolent tumors, but some can be aggressive. Surgery remains the only curative mode of treatment, and despite improvement in surgical techniques and safety, pancreatic resection continues to carry a significant risk of surgical morbidity. Numerous staging and prognostication systems1 have been developed to predict the clinical behavior of PNENs; however, this continues to be a clinical challenge.
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