To determine treatment strategies corresponding to a wide range of pancreatic neuroendocrine neoplasms staging, easier-to-use and detailed prognostic classification is required.
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.
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.
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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Published online: September 18, 2022
Accepted: August 4, 2022
© 2022 Elsevier Inc. All rights reserved.
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- 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.