Is the 2-cm size cutoff relevant for small nonfunctioning pancreatic neuroendocrine tumors: A French multicenter study

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• 作者：Nicolas Regenet ; MD^a ; ^{nicolas.regenet@chu-nantes.fr" class="auth_mail" title="E-mail the corresponding author} ; Nicolas Carrere ; MD ; PhD^b ; Guillaume Boulanger ; MD^a ; Loic de Calan ; MD^c ; Marine Humeau ; MD^b ; Vincent Arnault ; MD^c ; Jean-Louis Kraimps ; MD^d ; Murielle Mathonnet ; MD ; PhD^e ; Patrick Pessaux ; MD ; PhD^g ; Gianluca Donatini ; MD ; PhD ; FEBS^d ; Aurelien Venara ; MD^g ; Niki Christou ; MD^f ; Philippe Bachelier ; MD ; PhD^g ; Antoine Hamy ; MD^f ; Eric Mirallié ; MD^a
• 刊名：Surgery
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：159
• 期：3
• 页码：901-907
• 全文大小：250 K

文摘

Nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) are often discovered at a small size. No clear consensus exists on the management of NF-PNETs ≤ 2 cm. The aim of our study was to determine the prognostic value of indicators of malignancy in sporadic NF-PNETs ≤ 2 cm.

Methods

Eighty patients were evaluated retrospectively in 7 French University Hospital Centers. Patients were managed by operative resection (operative group [OG]) or observational follow-up (non-OG [NOG]). Pathologic characteristics and outcomes were analyzed.

Results

Sixty-six patients (58% women) were in the OG (mean age, 59 years; 95% CI, 56.0–62.3; mean tumor size, 1.6 cm; 95% CI, 1.5–1.7); 14 (72% women, n = 10) were in the NOG (mean age, 63 years; 95% CI, 56–70; mean tumor size, 1.4 cm; 95% CI, 1.0–1.7). All PNETs were ranked using the European Neuroendocrine Tumor Society grading system. Fifteen patients (19%) had malignant tumors defined by node or liver metastasis (synchronous or metachronous). The median disease-free survival was different between malignant and nonmalignant PNETs, respectively: 16 (range, 4–72) versus 30 months (range, 1–156; P = .03). On a receiver operating characteristic (ROC) curve, tumor size had a significant impact on malignancy (area under the curve [AUC], 0.75; P = .03), but not Ki-67 (AUC, 0.59; P = .31). A tumor size cutoff was found on the ROC curve at 1.7 cm (odd ratio, 10.8; 95% CI; 2.2–53.2; P = .003) with a sensitivity of 92% and a specificity of 75% to predict malignancy.

Conclusion

Based on our retrospective study, the cutoff of 2 cm of malignancy used for small NF-PNETs could be decreased to 1.7 cm to select patients more accurately.