Are There Prognostic Factors Related to Recurrence in Neuroendocrine Pancreatic Tumors?
Ricci C1, Campana D2, Morselli-Labate AM2, Antonacci N1, Casadei R1, Pezzilli R2, Rega D1, Calculli L3, Santini D4, D’Ambra M1, Alagna V1, Tomassetti P2, Minni F1
1Surgical Unit, 2Department of Digestive Diseases and Internal Medicine, 3Radiological Unit, 4Pathology Unit, S.Orsola-Malpighi Hospital, University of Bologna. Bologna, Italy
ABSTRACT
Context Recurrence rate in resected neuroendocrine pancreatic tumors is rarely reported in the literature. Usually tumor recurrence occurred in the liver with a median time of about 12 months. To our knowledge, prognostic factors related to recurrence have been rarely reported. Aim To individuate the possible factors related to the appearance of recurrences. Methods This study included a total of 65 patients having PNET admitted to our unit from 1980 to 2008 who underwent surgical R0 resection. There were 30 males, 35 females with mean age 52.3±13.8 years; 24 patients (36.9%) had functioning tumors, 33 (50.8%) non-functioning and 8 (12.3%) MEN 1. Symptoms were present in 50 cases (76.9%), while 15 patients (23.1%) were asymptomatic. The tumors was single in 58 cases (89.2%) and multiple in 7 (10.8%); the neoplasia was located in the pancreatic head in 19 cases (29.2%), in the body in 25 (38.5%), in the tail in 18 (27.7%) and it was diffuse throughout the gland in 3 cases (4.6%). Tumor size was 3.2±2.3 cm, Ki-67 was <2% in 13 cases (20%), ≥2% in 15 cases (23.1%), not available in the remaining 37 (56.9%). According to WHO stage, 43 patients (66.2%) had well differentiated endocrine tumors, 18 (27.7%) well differentiated endocrine carcinomas and 4 (6.2%) poorly differentiated endocrine carcinomas. According to TNM stage, 21 patients (32.3%) were stage I, 29 (44.6%) stage II, 13 (20.0%) stage III and 3 (3.1%) stage 4. Recurrence rate were calculated using Kaplan-Meier method. Cox regression was applied to identify prognostic factors. Results Recurrence rate was 24.5% (16 cases). Mean time to recurrence was of 7.3±4.5 years. Recurrence rate at 5, 10, and 15 years was 11.4%, 21.1% and 39.6%, respectively. The liver was the most common site of recurrence (12 cases, 75%). The factors significantly and positively related to recurrence were the presence of MEN 1 (P=0.047), Ki-67 ≥2% (P=0.008), metastatic node (P=0.05) and liver metastases (P=0.042), WHO (P=0.026) and TNM stage (P=0.019). Conclusion Several factors can determine the onset of recurrence. In particular, recurrence rate is high in patients with MEN 1, Ki-67 ≥2%, presence of nodal and liver metastasis, poorly differentiated carcinomas and stage III and IV.
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