A Prognostic Scoring System for the Prediction of Metastatic Recurrence Following Curative Resection of Pancreatic Neuroendocrine Tumors
Background Patients with early-stage pancreatic neuroendocrine tumors (PNETs) may develop metastatic recurrences despite undergoing potentially curative pancreas resections. We sought to identify factors predictive of metastatic recurrences and develop a prognostication strategy to predict recurrenc...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2019-07, Vol.23 (7), p.1392-1400 |
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| creator | Sho, Shonan Court, Colin M. Winograd, Paul Toste, Paul A. Pisegna, Joseph R. Lewis, Michael Donahue, Timothy R. Hines, Oscar J. Reber, Howard A. Dawson, David W. Tomlinson, James S. |
| description | Background
Patients with early-stage pancreatic neuroendocrine tumors (PNETs) may develop metastatic recurrences despite undergoing potentially curative pancreas resections. We sought to identify factors predictive of metastatic recurrences and develop a prognostication strategy to predict recurrence-free survival (RFS) in resected PNETs.
Methods
Patients with localized PNETs undergoing surgical resection between 1989 and 2015 were identified. Univariate and multivariate analysis were used to identify potential predictors of post-resection metastasis. A score-based prognostication system was devised using the identified factors. The bootstrap model validation methodology was utilized to estimate the external validity of the proposed prognostication strategy.
Results
Of the 140 patients with completely resected early-stage PNETs, overall 5- and 10-year RFS were 84.6% and 67.1%, respectively. The median follow-up was 56 months. Multivariate analysis identified tumor size > 5 cm, Ki-67 index 8–20%, lymph node involvement, and high histologic grade (G3, or Ki-67 > 20%) as independent predictors of post-resection metastatic recurrence. A scoring system based on these factors stratified patients into three prognostic categories with distinct 5-year RFS: 96.9%, 54.8%, and 33.3% (
P
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| doi_str_mv | 10.1007/s11605-018-4011-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6736531</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2124340443</sourcerecordid><originalsourceid>FETCH-LOGICAL-c536t-51db2c53c7ee90794b0e2ddd0fdb993427b06e9335a2d7c3d60142a2928de0bd3</originalsourceid><addsrcrecordid>eNp1kc1u1DAUhSMEoqXwAGyQJTZsAtd_8WSDVI0oIBWoaJHYWY59M02V2FPbKeob8Ng4TBl-JFa-0vnOub46VfWUwksKoF4lShuQNdBVLYDSWt2rDulK8Vo0rLlfZmhpzaT8elA9SukKgKrCPqwOOHDJxao9rL4fk7MYNj6kPFhybkMc_Iac36aME-lDJPkSC4FusHkInoSefMBsUjYL_xntHCN6i-QkjGP4tpjXcyziDRY14d51ZryN-NP1EecY0LtgyzIkF_MUYnpcPejNmPDJ3XtUfTl5c7F-V59-evt-fXxaW8mbXEvqOlZGqxBbUK3oAJlzDnrXtS0XTHXQYMu5NMwpy10DVDDDWrZyCJ3jR9XrXe527iZ0Fn2OZtTbOEwm3upgBv234odLvQk3ulG8kZyWgBd3ATFcz5iynoZkcRyNxzAnzSgrGLSSFfT5P-hVmKMv5y2U4AKE4IWiO8rGkFLEfv8ZCnrpWe961qU7vfSsVfE8-_OKveNXsQVgOyBtl0Yx_l79_9QfHES2PA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2124340443</pqid></control><display><type>article</type><title>A Prognostic Scoring System for the Prediction of Metastatic Recurrence Following Curative Resection of Pancreatic Neuroendocrine Tumors</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Sho, Shonan ; Court, Colin M. ; Winograd, Paul ; Toste, Paul A. ; Pisegna, Joseph R. ; Lewis, Michael ; Donahue, Timothy R. ; Hines, Oscar J. ; Reber, Howard A. ; Dawson, David W. ; Tomlinson, James S.</creator><creatorcontrib>Sho, Shonan ; Court, Colin M. ; Winograd, Paul ; Toste, Paul A. ; Pisegna, Joseph R. ; Lewis, Michael ; Donahue, Timothy R. ; Hines, Oscar J. ; Reber, Howard A. ; Dawson, David W. ; Tomlinson, James S.</creatorcontrib><description>Background
Patients with early-stage pancreatic neuroendocrine tumors (PNETs) may develop metastatic recurrences despite undergoing potentially curative pancreas resections. We sought to identify factors predictive of metastatic recurrences and develop a prognostication strategy to predict recurrence-free survival (RFS) in resected PNETs.
Methods
Patients with localized PNETs undergoing surgical resection between 1989 and 2015 were identified. Univariate and multivariate analysis were used to identify potential predictors of post-resection metastasis. A score-based prognostication system was devised using the identified factors. The bootstrap model validation methodology was utilized to estimate the external validity of the proposed prognostication strategy.
Results
Of the 140 patients with completely resected early-stage PNETs, overall 5- and 10-year RFS were 84.6% and 67.1%, respectively. The median follow-up was 56 months. Multivariate analysis identified tumor size > 5 cm, Ki-67 index 8–20%, lymph node involvement, and high histologic grade (G3, or Ki-67 > 20%) as independent predictors of post-resection metastatic recurrence. A scoring system based on these factors stratified patients into three prognostic categories with distinct 5-year RFS: 96.9%, 54.8%, and 33.3% (
P
< 0.0001). The bootstrap model validation methodology projected our proposed prognostication strategy to retain a high predictive accuracy even when applied in an external dataset (validated c-index of 0.81).
Conclusions
The combination of tumor size, LN status, grade, and Ki-67 was identified as the most highly predictive indicators of metastatic recurrences in resected PNETs. The proposed prognostication strategy may help stratify patients for adjuvant therapies, enhanced surveillance protocols and future clinical trials.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-018-4011-7</identifier><identifier>PMID: 30353489</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Aged ; Disease-Free Survival ; Female ; Gastroenterology ; Gastrointestinal surgery ; Humans ; Ki-67 Antigen - analysis ; Lymphatic Metastasis ; Male ; Medical prognosis ; Medicine ; Medicine & Public Health ; Metastasis ; Middle Aged ; Multivariate Analysis ; Neoplasm Grading ; Neuroendocrine tumors ; Neuroendocrine Tumors - pathology ; Neuroendocrine Tumors - surgery ; Original Article ; Pancreas ; Pancreatectomy ; Pancreatic cancer ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Prognosis ; Recurrence ; Retrospective Studies ; Surgery ; Tumor Burden</subject><ispartof>Journal of gastrointestinal surgery, 2019-07, Vol.23 (7), p.1392-1400</ispartof><rights>The Society for Surgery of the Alimentary Tract 2018</rights><rights>Journal of Gastrointestinal Surgery is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c536t-51db2c53c7ee90794b0e2ddd0fdb993427b06e9335a2d7c3d60142a2928de0bd3</citedby><cites>FETCH-LOGICAL-c536t-51db2c53c7ee90794b0e2ddd0fdb993427b06e9335a2d7c3d60142a2928de0bd3</cites><orcidid>0000-0002-1547-6402</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-018-4011-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-018-4011-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30353489$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sho, Shonan</creatorcontrib><creatorcontrib>Court, Colin M.</creatorcontrib><creatorcontrib>Winograd, Paul</creatorcontrib><creatorcontrib>Toste, Paul A.</creatorcontrib><creatorcontrib>Pisegna, Joseph R.</creatorcontrib><creatorcontrib>Lewis, Michael</creatorcontrib><creatorcontrib>Donahue, Timothy R.</creatorcontrib><creatorcontrib>Hines, Oscar J.</creatorcontrib><creatorcontrib>Reber, Howard A.</creatorcontrib><creatorcontrib>Dawson, David W.</creatorcontrib><creatorcontrib>Tomlinson, James S.</creatorcontrib><title>A Prognostic Scoring System for the Prediction of Metastatic Recurrence Following Curative Resection of Pancreatic Neuroendocrine Tumors</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Background
Patients with early-stage pancreatic neuroendocrine tumors (PNETs) may develop metastatic recurrences despite undergoing potentially curative pancreas resections. We sought to identify factors predictive of metastatic recurrences and develop a prognostication strategy to predict recurrence-free survival (RFS) in resected PNETs.
Methods
Patients with localized PNETs undergoing surgical resection between 1989 and 2015 were identified. Univariate and multivariate analysis were used to identify potential predictors of post-resection metastasis. A score-based prognostication system was devised using the identified factors. The bootstrap model validation methodology was utilized to estimate the external validity of the proposed prognostication strategy.
Results
Of the 140 patients with completely resected early-stage PNETs, overall 5- and 10-year RFS were 84.6% and 67.1%, respectively. The median follow-up was 56 months. Multivariate analysis identified tumor size > 5 cm, Ki-67 index 8–20%, lymph node involvement, and high histologic grade (G3, or Ki-67 > 20%) as independent predictors of post-resection metastatic recurrence. A scoring system based on these factors stratified patients into three prognostic categories with distinct 5-year RFS: 96.9%, 54.8%, and 33.3% (
P
< 0.0001). The bootstrap model validation methodology projected our proposed prognostication strategy to retain a high predictive accuracy even when applied in an external dataset (validated c-index of 0.81).
Conclusions
The combination of tumor size, LN status, grade, and Ki-67 was identified as the most highly predictive indicators of metastatic recurrences in resected PNETs. The proposed prognostication strategy may help stratify patients for adjuvant therapies, enhanced surveillance protocols and future clinical trials.</description><subject>Adult</subject><subject>Aged</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Humans</subject><subject>Ki-67 Antigen - analysis</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Grading</subject><subject>Neuroendocrine tumors</subject><subject>Neuroendocrine Tumors - pathology</subject><subject>Neuroendocrine Tumors - surgery</subject><subject>Original Article</subject><subject>Pancreas</subject><subject>Pancreatectomy</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Prognosis</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Tumor Burden</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kc1u1DAUhSMEoqXwAGyQJTZsAtd_8WSDVI0oIBWoaJHYWY59M02V2FPbKeob8Ng4TBl-JFa-0vnOub46VfWUwksKoF4lShuQNdBVLYDSWt2rDulK8Vo0rLlfZmhpzaT8elA9SukKgKrCPqwOOHDJxao9rL4fk7MYNj6kPFhybkMc_Iac36aME-lDJPkSC4FusHkInoSefMBsUjYL_xntHCN6i-QkjGP4tpjXcyziDRY14d51ZryN-NP1EecY0LtgyzIkF_MUYnpcPejNmPDJ3XtUfTl5c7F-V59-evt-fXxaW8mbXEvqOlZGqxBbUK3oAJlzDnrXtS0XTHXQYMu5NMwpy10DVDDDWrZyCJ3jR9XrXe527iZ0Fn2OZtTbOEwm3upgBv234odLvQk3ulG8kZyWgBd3ATFcz5iynoZkcRyNxzAnzSgrGLSSFfT5P-hVmKMv5y2U4AKE4IWiO8rGkFLEfv8ZCnrpWe961qU7vfSsVfE8-_OKveNXsQVgOyBtl0Yx_l79_9QfHES2PA</recordid><startdate>20190701</startdate><enddate>20190701</enddate><creator>Sho, Shonan</creator><creator>Court, Colin M.</creator><creator>Winograd, Paul</creator><creator>Toste, Paul A.</creator><creator>Pisegna, Joseph R.</creator><creator>Lewis, Michael</creator><creator>Donahue, Timothy R.</creator><creator>Hines, Oscar J.</creator><creator>Reber, Howard A.</creator><creator>Dawson, David W.</creator><creator>Tomlinson, James S.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1547-6402</orcidid></search><sort><creationdate>20190701</creationdate><title>A Prognostic Scoring System for the Prediction of Metastatic Recurrence Following Curative Resection of Pancreatic Neuroendocrine Tumors</title><author>Sho, Shonan ; Court, Colin M. ; Winograd, Paul ; Toste, Paul A. ; Pisegna, Joseph R. ; Lewis, Michael ; Donahue, Timothy R. ; Hines, Oscar J. ; Reber, Howard A. ; Dawson, David W. ; Tomlinson, James S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c536t-51db2c53c7ee90794b0e2ddd0fdb993427b06e9335a2d7c3d60142a2928de0bd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Humans</topic><topic>Ki-67 Antigen - analysis</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Grading</topic><topic>Neuroendocrine tumors</topic><topic>Neuroendocrine Tumors - pathology</topic><topic>Neuroendocrine Tumors - surgery</topic><topic>Original Article</topic><topic>Pancreas</topic><topic>Pancreatectomy</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Prognosis</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Tumor Burden</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sho, Shonan</creatorcontrib><creatorcontrib>Court, Colin M.</creatorcontrib><creatorcontrib>Winograd, Paul</creatorcontrib><creatorcontrib>Toste, Paul A.</creatorcontrib><creatorcontrib>Pisegna, Joseph R.</creatorcontrib><creatorcontrib>Lewis, Michael</creatorcontrib><creatorcontrib>Donahue, Timothy R.</creatorcontrib><creatorcontrib>Hines, Oscar J.</creatorcontrib><creatorcontrib>Reber, Howard A.</creatorcontrib><creatorcontrib>Dawson, David W.</creatorcontrib><creatorcontrib>Tomlinson, James S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sho, Shonan</au><au>Court, Colin M.</au><au>Winograd, Paul</au><au>Toste, Paul A.</au><au>Pisegna, Joseph R.</au><au>Lewis, Michael</au><au>Donahue, Timothy R.</au><au>Hines, Oscar J.</au><au>Reber, Howard A.</au><au>Dawson, David W.</au><au>Tomlinson, James S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Prognostic Scoring System for the Prediction of Metastatic Recurrence Following Curative Resection of Pancreatic Neuroendocrine Tumors</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2019-07-01</date><risdate>2019</risdate><volume>23</volume><issue>7</issue><spage>1392</spage><epage>1400</epage><pages>1392-1400</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Background
Patients with early-stage pancreatic neuroendocrine tumors (PNETs) may develop metastatic recurrences despite undergoing potentially curative pancreas resections. We sought to identify factors predictive of metastatic recurrences and develop a prognostication strategy to predict recurrence-free survival (RFS) in resected PNETs.
Methods
Patients with localized PNETs undergoing surgical resection between 1989 and 2015 were identified. Univariate and multivariate analysis were used to identify potential predictors of post-resection metastasis. A score-based prognostication system was devised using the identified factors. The bootstrap model validation methodology was utilized to estimate the external validity of the proposed prognostication strategy.
Results
Of the 140 patients with completely resected early-stage PNETs, overall 5- and 10-year RFS were 84.6% and 67.1%, respectively. The median follow-up was 56 months. Multivariate analysis identified tumor size > 5 cm, Ki-67 index 8–20%, lymph node involvement, and high histologic grade (G3, or Ki-67 > 20%) as independent predictors of post-resection metastatic recurrence. A scoring system based on these factors stratified patients into three prognostic categories with distinct 5-year RFS: 96.9%, 54.8%, and 33.3% (
P
< 0.0001). The bootstrap model validation methodology projected our proposed prognostication strategy to retain a high predictive accuracy even when applied in an external dataset (validated c-index of 0.81).
Conclusions
The combination of tumor size, LN status, grade, and Ki-67 was identified as the most highly predictive indicators of metastatic recurrences in resected PNETs. The proposed prognostication strategy may help stratify patients for adjuvant therapies, enhanced surveillance protocols and future clinical trials.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30353489</pmid><doi>10.1007/s11605-018-4011-7</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1547-6402</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of gastrointestinal surgery, 2019-07, Vol.23 (7), p.1392-1400 |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Adult Aged Disease-Free Survival Female Gastroenterology Gastrointestinal surgery Humans Ki-67 Antigen - analysis Lymphatic Metastasis Male Medical prognosis Medicine Medicine & Public Health Metastasis Middle Aged Multivariate Analysis Neoplasm Grading Neuroendocrine tumors Neuroendocrine Tumors - pathology Neuroendocrine Tumors - surgery Original Article Pancreas Pancreatectomy Pancreatic cancer Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Prognosis Recurrence Retrospective Studies Surgery Tumor Burden |
| title | A Prognostic Scoring System for the Prediction of Metastatic Recurrence Following Curative Resection of Pancreatic Neuroendocrine Tumors |
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