A Lymph Node Ratio-Based Staging Model Is Superior to the Current Staging System for Pancreatic Neuroendocrine Tumors. J Clin Endocrinol Metab 2018 Jan 01;103(1):187-195
Date
10/27/2017Pubmed ID
29069375Pubmed Central ID
PMC5761495DOI
10.1210/jc.2017-01791Scopus ID
2-s2.0-85045970620 (requires institutional sign-in at Scopus site) 18 CitationsAbstract
CONTEXT: The incidence of pancreatic neuroendocrine tumors (PNETs) is increasing. Current staging systems include nodal positivity, but the association of lymph node status and worse survival is controversial.
OBJECTIVE: The study aim was to determine the prognostic significance of lymph node ratio (LNR) and compare it with nodal positivity for PNET.
DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION: A retrospective analysis of the Surveillance, Epidemiology, and End Results database between 2004 and 2011 was performed in patients who underwent a pancreatectomy with lymphadenectomy. The primary outcome was disease-specific survival (DSS).
RESULTS: Of the 896 patients analyzed, T stage, N stage, distant metastasis, grade, extent of resection, sex, and age ≥57 years were significantly associated with worse DSS on univariate analysis. On multivariate analysis, age ≥57 [hazard ratio (HR) 1.75, 95% confidence interval (CI), 1.12 to 2.74, P = 0.015], male sex (HR 1.58; 95% CI, 1.01 to 2.48; P = 0.046), grade (poorly differentiated/undifferentiated: HR 7.59; 95% CI, 4.71 to 12.23; P < 0.001), distant metastases (HR 2.45; 95% CI, 1.58 to 3.79; P < 0.001), and partial pancreatectomy (HR 2.55; 95% CI, 1.2 to 5.4; P = 0.015) were associated with worse DSS. Comparison between staging models constructed based on LNR cutoffs and the American Joint Committee on Cancer (AJCC) eighth edition staging system revealed that a model based on LNR ≥0.5 was superior.
CONCLUSIONS: LNR ≥0.5 is independently associated with worse DSS. A staging system with LNR ≥0.5 was superior to the current AJCC eighth edition staging system.
Author List
Gaitanidis A, Patel D, Nilubol N, Tirosh A, Kebebew EMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Lymph Nodes
Lymphatic Metastasis
Male
Middle Aged
Models, Statistical
Neoplasm Staging
Neuroendocrine Tumors
Pancreatectomy
Pancreatic Neoplasms
Retrospective Studies
SEER Program
Survival Rate
Young Adult
