Tumor burden score predicts tumor recurrence of non-functional pancreatic neuroendocrine tumors after curative resection

• Authors: Ding-Hui Dong, Xi An Jiao Tong University; Xu-Feng Zhang, Xi An Jiao Tong University; Alexandra G Lopez-Aguiar, Emory University; George Poultsides, Stanford University; Eleftherios 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; Carl R Schmidt, Ohio State University; Mary Dillhoff, Ohio State University; Shishir Maithel, Emory University; Timothy M Pawlik, Ohio State University
• Journal Title: HPB
• Volume: Volume 22, Number 8
• Publisher: ELSEVIER SCI LTD | 2020-08-01, Pages 1149-1157
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.hpb.2019.11.009
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Gastroenterology & Hepatology; Surgery; METASTASES; MANAGEMENT; FEATURES; SURGERY; TERM; TOOL

Abstract

Background: To investigate the feasibility of Tumor Burden Score (TBS) to predict tumor recurrence following curative-intent resection of non-functional pancreatic neuroendocrine tumors (NF-pNETs). Method: The TBS cut-off values were determined by a statistical tool, X-tile. The influence of TBS on recurrence-free survival (RFS) was examined. Results: Among 842 NF-pNETs patients, there was an incremental worsening of RFS as the TBS increased (5-year RFS, low, medium, and high TBS: 92.0%, 73.3%, and 59.3%, respectively; P < 0.001). TBS (AUC 0.74) out-performed both maximum tumor size (AUC 0.65) and number of tumors (AUC 0.5) to predict RFS (TBS vs. maximum tumor size, p = 0.05; TBS vs. number of tumors, p < 0.01). The impact of margin (low TBS: R0 80.4% vs. R1 71.9%, p = 0.01 vs. medium TBS: R0 55.8% vs. R1 37.5%, p = 0.67 vs. high TBS: R0 31.9% vs. R1 12.0%, p = 0.11) and nodal (5-year RFS, low TBS: N0 94.9% vs. N1 68.4%, p < 0.01 vs. medium TBS: N0 81.8% vs. N1 55.4%, p < 0.01 vs. high TBS: N0 58.0% vs. N1 54.2%, p = 0.15) status on 5-year RFS outcomes disappeared among patients who had higher TBS. Conclusions: TBS was strongly associated with risk of recurrence and outperformed both tumor size and number alone.