New Nodal Staging for Primary Pancreatic Neuroendocrine Tumors A Multi-institutional and National Data Analysis

• Type of Material: Article
• Authors: Xu-Feng Zhang, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China; Feng Xue, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China; Ding-Hui Dong, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China; Alexandra G Lopez-Aguiar, Emory University; George Poultsides, Stanford University; Eleftherios Makris, Stanford University; Flavio Rocha, Virginia Mason Medical Center, Seattle; Zaheer Kanji, Virginia Mason Medical Center, Seattle; Sharon Weber, University of Wisconsin; Alexander Fisher, University of Wisconsin; Ryan Fields, Washington University; Bradley A Krasnick, Washington University; Kamran Idrees, Vanderbilt University; Paula M Smith, Vanderbilt University; Cliff Cho, University of Michigan; Megan Beems, University of Michigan; Yi Lv, the First Affiliated Hospital of Xi’an Jiaotong University; Shishir Maithel, Emory University; Timothy M Pawlik, Ohio State University
• Language: English
• Date: 2021-07-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/SLA.0000000000003478
• Title of Journal or Parent Work: ANNALS OF SURGERY
• Volume: 274
• Issue: 1
• Start Page: E28
• End Page: E35
• Keywords: LYMPHADENECTOMY; neuroendocrine tumor; lymph node status; surgery; Life Sciences & Biomedicine; prognosis; SURVIVAL; RATIO; LYMPH-NODES; pancreas; RESECTION; Surgery; PROGNOSTIC-FACTORS; Science & Technology

Abstract

Objective:To determine the prognostic role of metastatic lymph node (LN) number and the minimal number of LNs for optimal staging of patients with pancreatic neuroendocrine tumors (pNETs).Background:Prognosis relative to number of LN metastasis (LNM), and minimal number of LNs needed to evaluate for accurate staging, have been poorly defined for pNETs.Methods:Number of LNM and total number of LN evaluated (TNLE) were assessed relative to recurrence-free survival (RFS) and overall survival (OS) in a multi-institutional database. External validation was performed using Surveillance, Epidemiology and End Results (SEER) registry.Results:Among 854 patients who underwent resection, 233 (27.3%) had at least 1 LNM. Patients with 1, 2, or 3 LNM had a comparable worse RFS versus patients with no nodal metastasis (5-year RFS, 1 LNM 65.6%, 2 LNM 68.2%, 3 LNM 63.2% vs 0 LNM 82.6%; all P < 0.001). In contrast, patients with ≥4 LNM (proposed N2) had a worse RFS versus patients who either had 1 to 3 LNM (proposed N1) or node-negative disease (5-year RFS, ≥4 LNM 43.5% vs 1-3 LNM 66.3%, 0 LNM 82.6%; all P < 0.05) [C-statistics area under the curve (AUC) 0.650]. TNLE ≥8 had the highest discriminatory power relative to RFS (AUC 0.713) and OS (AUC 0.726) among patients who had 1 to 3 LNM, and patients who had ≥4 LNM in the multi-institutional and SEER database (n = 2764).Conclusions:Regional lymphadenectomy of at least 8 lymph nodes was necessary to stage patients accurately. The proposed nodal staging of N0, N1, and N2 optimally staged patients.