TY - JOUR
T1 - Surgical Resection Provides an Overall Survival Benefit for Patients with Small Pancreatic Neuroendocrine Tumors
AU - Sharpe, Susan M.
AU - In, Haejin
AU - Winchester, David J.
AU - Talamonti, Mark S.
AU - Baker, Marshall S.
N1 - Publisher Copyright:
© 2014, The Society for Surgery of the Alimentary Tract.
PY - 2014/1
Y1 - 2014/1
N2 - Background: The optimal management of small (≤2 cm) pancreatic neuroendocrine tumors (PNETs) remains controversial. We evaluated these tumors in the National Cancer Data Base (NCDB) to determine if resection provides a survival advantage over observation.Methods: The NCDB was queried to identify patients with nonmetastatic PNETs ≤2 cm treated between 1998 and 2006. Kaplan-Meier survival estimates, stratified by grade and treatment type, evaluated the difference in 5-year overall survival (OS) between patients who underwent resection and observation. Multivariable Cox regression was used to determine the importance of resection in OS.Results: Three hundred eighty patients met inclusion criteria. Eighty-one percent underwent resection; 19 % were observed. Five-year OS was 82.2 % for patients who underwent surgery and 34.3 % for those who were observed (p < 0.0001). When controlling for age, comorbidities, income, facility type, tumor size and location, grade, margin status, nodal status, surgical management, and nonsurgical therapy in the Cox model, observation [hazard ratio (HR) 2.80], poorly differentiated histology (HR 3.79), lymph node positivity (HR 2.01), and nonsurgical therapies (HR 2.23) were independently associated with an increase in risk of mortality (p < 0.01).Conclusion: Patients with localized PNETs ≤2 cm had an overall survival advantage with resection compared to observation, independent of age, comorbidities, tumor grade, and treatment with nonsurgical therapies.
AB - Background: The optimal management of small (≤2 cm) pancreatic neuroendocrine tumors (PNETs) remains controversial. We evaluated these tumors in the National Cancer Data Base (NCDB) to determine if resection provides a survival advantage over observation.Methods: The NCDB was queried to identify patients with nonmetastatic PNETs ≤2 cm treated between 1998 and 2006. Kaplan-Meier survival estimates, stratified by grade and treatment type, evaluated the difference in 5-year overall survival (OS) between patients who underwent resection and observation. Multivariable Cox regression was used to determine the importance of resection in OS.Results: Three hundred eighty patients met inclusion criteria. Eighty-one percent underwent resection; 19 % were observed. Five-year OS was 82.2 % for patients who underwent surgery and 34.3 % for those who were observed (p < 0.0001). When controlling for age, comorbidities, income, facility type, tumor size and location, grade, margin status, nodal status, surgical management, and nonsurgical therapy in the Cox model, observation [hazard ratio (HR) 2.80], poorly differentiated histology (HR 3.79), lymph node positivity (HR 2.01), and nonsurgical therapies (HR 2.23) were independently associated with an increase in risk of mortality (p < 0.01).Conclusion: Patients with localized PNETs ≤2 cm had an overall survival advantage with resection compared to observation, independent of age, comorbidities, tumor grade, and treatment with nonsurgical therapies.
KW - Neuroendocrine
KW - Pancreas
KW - Surgery
KW - Survival
KW - Tumor
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U2 - 10.1007/s11605-014-2615-0
DO - 10.1007/s11605-014-2615-0
M3 - Article
C2 - 25155459
AN - SCOPUS:84920572721
SN - 1091-255X
VL - 19
SP - 117
EP - 123
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 1
ER -
