Resection of pancreatic neuroendocrine tumors: defining patterns and time course of recurrence

• Type of Material: Article
• Authors: Ding-Hui Dong, The First Affiliated Hospital of Xi’an Jiaotong University; Xu-Feng Zhang, The First Affiliated Hospital of Xi’an Jiaotong University; Alexandra G Lopez-Aguiar, Emory University; George Poultsides, Stanford University; Elefherios Makris, Stanford University; Flavio Rocha, Virginia Mason Medical Center; Zaheer Kanji, Virginia Mason Medical Center; 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; Mary Dillhoff, Ohio State University; Shishir Maithel, Emory University; Timothy M Pawlik, Ohio State University
• Language: English
• Date: 2020-02-01
• Publisher: ELSEVIER SCI LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.hpb.2019.05.020
• Title of Journal or Parent Work: HPB
• Volume: 22
• Issue: 2
• Start Page: 215
• End Page: 223
• Keywords: Gastroenterology & Hepatology; SURGERY; MANAGEMENT; KI67; Life Sciences & Biomedicine; OUTCOMES; CM; LIVER METASTASIS; Surgery; GUIDELINES; Science & Technology; DIAGNOSIS

Abstract

Background: To define recurrence patterns and time course, as well as risk factors associated with recurrence following curative resection of pNETs. Method: Patients who underwent curative-intent resection for pNET between 1997 and 2016 were identified from the US Neuroendocrine Tumor Study Group. Data on baseline and tumor-specific characteristics, overall survival (OS), timing and first-site of recurrence, predictors and recurrence management were analyzed. Results: Among 1020 patients, 154 (15.1%) patients developed recurrence. Among patients who experienced recurrence, 76 (49.4%) had liver-only recurrence, while 35 (22.7%) had pancreas-only recurrence. The proportion of liver-only recurrence increased from 54.3% within one-year after surgery to 61.5% from four-to-six years after surgery; whereas the proportion of pancreas-only recurrence decreased from 26.1% to 7.7% over these time periods. While liver-only recurrence was associated with tumor characteristics, pancreas-only recurrence was only associated with surgical margin status. Patients undergoing curative resection of recurrence had comparable OS with patients who had no recurrence (median OS, pancreas-only recurrence, 133.9 months; liver-only recurrence, not attained; no recurrence, 143.0 months, p = 0.499) Conclusions: Different recurrence patterns and timing course, as well as risk factors suggest biological heterogeneity of pNET recurrence. A personalized approach to postoperative surveillance and treatment of recurrence disease should be considered.