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Prognostic predictors for recurrence following curative resection in grade I/II pancreatic neuroendocrine tumours

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Abstract

Introduction

Pancreatic neuroendocrine tumours (pNETs) have an excellent long-term survival after resection, but are associated with a high recurrence rate. Identification of prognostic factors affecting recurrences would enable identifying subgroup of patients at higher risk of recurrences, who may benefit from more aggressive treatment.

Methods

A retrospective analysis of prospectively maintained database of patients undergoing pancreatectomy with curative intent for grade I and II pNETs between July 2007 and June 2021 was performed. Perioperative and long-term outcomes were analysed.

Results

A total of 68 resected patients of pNETs were included in this analysis. Fifty-two patients (76.47%) underwent pancreaticoduodenectomy, 10 (14.7%) patients had distal pancreatectomy, and 2 (2.9%) patients underwent median pancreatectomy, while enucleation was performed in 4 patients (5.8%). The overall major morbidity (Clavien-Dindo III/IV) and mortality rates were 33.82% and 2.94%, respectively. At a median follow-up period of 48 months, 22 (32.35%) patients had disease recurrence. The 5-year overall survival and 5-year recurrence-free survival (RFS) rates were 90.2% and 60.8%, respectively. While OS was unaffected by different prognostic factors, multivariate analysis showed that lymph node involvement, Ki-67 index ≥5%, and presence of perineural invasion (PNI) were independently associated with recurrence.

Conclusions

While surgical resection gives excellent overall survival in grade I/II pNETs, lymph node positivity, higher Ki-67 index, and PNI are associated with a high risk for recurrence. Patients with these characteristics should be stratified as high risk and evaluated for more intensive follow-up and aggressive treatment strategies in future prospective studies.

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Authors and Affiliations

  1. Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India

    Amit Chopde, Vikram Chaudhari, Shailesh V. Shrikhande & Manish S. Bhandare

  2. Homi bhabha National Institute, Mumbai, India

    Amit Chopde, Vikram Chaudhari, Rahul Parghane, Sandip Basu, Vikas Ostwal, Anant Ramaswamy, Ameya Puranik, Shailesh V. Shrikhande & Manish S. Bhandare

  3. Department of Surgical Oncology, Cancer Care, Gujrat, Surat, 395002, India

    Amit Gupta

  4. Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, Maharashtra, India

    Rahul Parghane & Sandip Basu

  5. Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India

    Vikas Ostwal & Anant Ramaswamy

  6. Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India

    Ameya Puranik

Authors
  1. Amit Chopde
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Contributions

Conceptualisation: All

Design: Chopde, Bhandare, Shrikhande, Gupta, Basu, Puranik,Ramaswamy

Data acquisition: Chopde, Gupta, Chaudhari, Parghane, Ostwal

Analysis: Chopde, Bhandare, Chaudhari, Parghane, Puranik, Ramaswamy

First draft: Chopde, Chaudhari, Ostwal.

Critical editing/revision: Basu, Bhandare, Parghane, Ramaswamy, Shrikhande

Corresponding author

Correspondence to Manish S. Bhandare.

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Chopde, A., Gupta, A., Chaudhari, V. et al. Prognostic predictors for recurrence following curative resection in grade I/II pancreatic neuroendocrine tumours. Langenbecks Arch Surg 408, 204 (2023). https://doi.org/10.1007/s00423-023-02943-z

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