A New Scoring System to Predict Recurrent Disease in Grade 1 and 2 Nonfunctional Pancreatic Neuroendocrine Tumors

CG Genç, AP Jilesen, S Partelli, M Falconi, F Muffatti, FJ Van Kemenade, S Van Eeden, J Verheij, S Van Dieren, CHJ Van Eijck, EJM Nieveen Van Dijkum

Research output: Contribution to journalArticle

Abstract

Objective: The aim of this study was to predict recurrence in patients with grade 1 or 2 nonfunctioning pancreatic neuroendocrine tumors (NF-pNET) after curative resection. Background: Surgical resection is the preferred treatment for NF-pNET; however, recurrence occurs frequently after curative surgery, worsening prognosis of patients. Methods: Retrospectively, patients with NF-pNET of 3 institutions were included. Patients with distant metastases, hereditary syndromes, or grade 3 tumors were excluded. Local or distant tumor recurrence was scored. Independent predictors for survival and recurrence were identified using Cox-regression analysis. The recurrence score was developed to predict recurrence within 5 years after curative resection of grade 1 to 2 NF-pNET. Results: With a median follow-up of 51 months, 211 patients with grade 1 to 2 NF-pNET were included. Thirty-five patients (17%) developed recurrence. The 5- and 10-year disease-specific/overall survival was 98%/91% and 84%/68%, respectively. Predictors for recurrence were tumor grade 2, lymph node metastasis, and perineural invasion. On the basis of these predictors, the recurrence score was made. Discrimination [c-statistic 0.81, 95% confidence interval (95% CI) 0.75-0.87] and calibration (Hosmer Lemeshow Chi-square 11.25, P = 0.258) indicated that the ability of the recurrence score to identify patients at risk for recurrence is good. Conclusions: This new scoring system could predict recurrence after curative resection of grade 1 and 2 NF-pNET. With the use of the recurrence score, less extensive follow-up could be proposed for patients with low recurrence risk. For high-risk patients, clinical trials should be initiated to investigate whether adjuvant therapy might be beneficial. External validation is ongoing due to limited availability of adequate cohorts. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Original languageEnglish
Pages (from-to)1148-1154
Number of pages7
JournalAnnals of Surgery
Volume267
Issue number6
DOIs
Publication statusPublished - 2018

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Neuroendocrine Tumors
Recurrence
Neoplasm Metastasis
Neoplasms
Survival
Calibration

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A New Scoring System to Predict Recurrent Disease in Grade 1 and 2 Nonfunctional Pancreatic Neuroendocrine Tumors. / Genç, CG; Jilesen, AP; Partelli, S; Falconi, M; Muffatti, F; Van Kemenade, FJ; Van Eeden, S; Verheij, J; Van Dieren, S; Van Eijck, CHJ; Nieveen Van Dijkum, EJM.

In: Annals of Surgery, Vol. 267, No. 6, 2018, p. 1148-1154.

Research output: Contribution to journalArticle

Genç, CG, Jilesen, AP, Partelli, S, Falconi, M, Muffatti, F, Van Kemenade, FJ, Van Eeden, S, Verheij, J, Van Dieren, S, Van Eijck, CHJ & Nieveen Van Dijkum, EJM 2018, 'A New Scoring System to Predict Recurrent Disease in Grade 1 and 2 Nonfunctional Pancreatic Neuroendocrine Tumors', Annals of Surgery, vol. 267, no. 6, pp. 1148-1154. https://doi.org/10.1097/SLA.0000000000002123
Genç, CG ; Jilesen, AP ; Partelli, S ; Falconi, M ; Muffatti, F ; Van Kemenade, FJ ; Van Eeden, S ; Verheij, J ; Van Dieren, S ; Van Eijck, CHJ ; Nieveen Van Dijkum, EJM. / A New Scoring System to Predict Recurrent Disease in Grade 1 and 2 Nonfunctional Pancreatic Neuroendocrine Tumors. In: Annals of Surgery. 2018 ; Vol. 267, No. 6. pp. 1148-1154.
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abstract = "Objective: The aim of this study was to predict recurrence in patients with grade 1 or 2 nonfunctioning pancreatic neuroendocrine tumors (NF-pNET) after curative resection. Background: Surgical resection is the preferred treatment for NF-pNET; however, recurrence occurs frequently after curative surgery, worsening prognosis of patients. Methods: Retrospectively, patients with NF-pNET of 3 institutions were included. Patients with distant metastases, hereditary syndromes, or grade 3 tumors were excluded. Local or distant tumor recurrence was scored. Independent predictors for survival and recurrence were identified using Cox-regression analysis. The recurrence score was developed to predict recurrence within 5 years after curative resection of grade 1 to 2 NF-pNET. Results: With a median follow-up of 51 months, 211 patients with grade 1 to 2 NF-pNET were included. Thirty-five patients (17{\%}) developed recurrence. The 5- and 10-year disease-specific/overall survival was 98{\%}/91{\%} and 84{\%}/68{\%}, respectively. Predictors for recurrence were tumor grade 2, lymph node metastasis, and perineural invasion. On the basis of these predictors, the recurrence score was made. Discrimination [c-statistic 0.81, 95{\%} confidence interval (95{\%} CI) 0.75-0.87] and calibration (Hosmer Lemeshow Chi-square 11.25, P = 0.258) indicated that the ability of the recurrence score to identify patients at risk for recurrence is good. Conclusions: This new scoring system could predict recurrence after curative resection of grade 1 and 2 NF-pNET. With the use of the recurrence score, less extensive follow-up could be proposed for patients with low recurrence risk. For high-risk patients, clinical trials should be initiated to investigate whether adjuvant therapy might be beneficial. External validation is ongoing due to limited availability of adequate cohorts. Copyright {\circledC} 2017 Wolters Kluwer Health, Inc. All rights reserved.",
author = "CG Gen{\cc} and AP Jilesen and S Partelli and M Falconi and F Muffatti and {Van Kemenade}, FJ and {Van Eeden}, S and J Verheij and {Van Dieren}, S and {Van Eijck}, CHJ and {Nieveen Van Dijkum}, EJM",
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TY - JOUR

T1 - A New Scoring System to Predict Recurrent Disease in Grade 1 and 2 Nonfunctional Pancreatic Neuroendocrine Tumors

AU - Genç, CG

AU - Jilesen, AP

AU - Partelli, S

AU - Falconi, M

AU - Muffatti, F

AU - Van Kemenade, FJ

AU - Van Eeden, S

AU - Verheij, J

AU - Van Dieren, S

AU - Van Eijck, CHJ

AU - Nieveen Van Dijkum, EJM

PY - 2018

Y1 - 2018

N2 - Objective: The aim of this study was to predict recurrence in patients with grade 1 or 2 nonfunctioning pancreatic neuroendocrine tumors (NF-pNET) after curative resection. Background: Surgical resection is the preferred treatment for NF-pNET; however, recurrence occurs frequently after curative surgery, worsening prognosis of patients. Methods: Retrospectively, patients with NF-pNET of 3 institutions were included. Patients with distant metastases, hereditary syndromes, or grade 3 tumors were excluded. Local or distant tumor recurrence was scored. Independent predictors for survival and recurrence were identified using Cox-regression analysis. The recurrence score was developed to predict recurrence within 5 years after curative resection of grade 1 to 2 NF-pNET. Results: With a median follow-up of 51 months, 211 patients with grade 1 to 2 NF-pNET were included. Thirty-five patients (17%) developed recurrence. The 5- and 10-year disease-specific/overall survival was 98%/91% and 84%/68%, respectively. Predictors for recurrence were tumor grade 2, lymph node metastasis, and perineural invasion. On the basis of these predictors, the recurrence score was made. Discrimination [c-statistic 0.81, 95% confidence interval (95% CI) 0.75-0.87] and calibration (Hosmer Lemeshow Chi-square 11.25, P = 0.258) indicated that the ability of the recurrence score to identify patients at risk for recurrence is good. Conclusions: This new scoring system could predict recurrence after curative resection of grade 1 and 2 NF-pNET. With the use of the recurrence score, less extensive follow-up could be proposed for patients with low recurrence risk. For high-risk patients, clinical trials should be initiated to investigate whether adjuvant therapy might be beneficial. External validation is ongoing due to limited availability of adequate cohorts. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

AB - Objective: The aim of this study was to predict recurrence in patients with grade 1 or 2 nonfunctioning pancreatic neuroendocrine tumors (NF-pNET) after curative resection. Background: Surgical resection is the preferred treatment for NF-pNET; however, recurrence occurs frequently after curative surgery, worsening prognosis of patients. Methods: Retrospectively, patients with NF-pNET of 3 institutions were included. Patients with distant metastases, hereditary syndromes, or grade 3 tumors were excluded. Local or distant tumor recurrence was scored. Independent predictors for survival and recurrence were identified using Cox-regression analysis. The recurrence score was developed to predict recurrence within 5 years after curative resection of grade 1 to 2 NF-pNET. Results: With a median follow-up of 51 months, 211 patients with grade 1 to 2 NF-pNET were included. Thirty-five patients (17%) developed recurrence. The 5- and 10-year disease-specific/overall survival was 98%/91% and 84%/68%, respectively. Predictors for recurrence were tumor grade 2, lymph node metastasis, and perineural invasion. On the basis of these predictors, the recurrence score was made. Discrimination [c-statistic 0.81, 95% confidence interval (95% CI) 0.75-0.87] and calibration (Hosmer Lemeshow Chi-square 11.25, P = 0.258) indicated that the ability of the recurrence score to identify patients at risk for recurrence is good. Conclusions: This new scoring system could predict recurrence after curative resection of grade 1 and 2 NF-pNET. With the use of the recurrence score, less extensive follow-up could be proposed for patients with low recurrence risk. For high-risk patients, clinical trials should be initiated to investigate whether adjuvant therapy might be beneficial. External validation is ongoing due to limited availability of adequate cohorts. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

U2 - 10.1097/SLA.0000000000002123

DO - 10.1097/SLA.0000000000002123

M3 - Article

VL - 267

SP - 1148

EP - 1154

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 6

ER -