Ki-67 and presence of liver metastases identify different progression-risk classes in pancreatic neuroendocrine neoplasms (pNEN) undergoing resection

Research output: Contribution to journalArticle

Abstract

In pancreatic neuroendocrine neoplasms (pNEN), size ≤2 cm and Ki-67 < 3% suggest indolent behavior, but no factor alone predicts prognosis. We investigated factors predictive of tumor progression in 80 pNENs surgically resected in a single Institution from 1995 to 2015. At multivariable analysis the only two independent variables related to PFS were Ki-67 (HR 2.97; 95%CI 1.26–7.02) and presence of synchronous liver metastases (HR 3.60; 95%CI 1.70–7.61). Using Ki-67 < 3% and M0 as reference, the HR for tumor progression was 3.21 (95%CI 1.18–8.74) for M0 patients with Ki-67 3–20%, 5.06 (2.29–11.2) for M1 patients with Ki-67 ≤ 20% and 24.3 (6.64–89.2) for those with Ki-67 > 20%. Tumor size (≤2 vs. >2 cm) was not a predictive factor at any analysis. Intra-class correlation of Ki-67 values on pre-surgical biopsies vs. surgical specimens was 0.99 and Ki-67 classes were correctly identified in 97% of biopsies. Ki-67 and presence of liver metastases are the major prognostic factors in pNEN and identify different progression risks regardless of tumor size. Pre-surgical pNEN biopsy for Ki-67 assessment should be included in the evaluation of patients with 1–2 cm tumors to help in the decision on whether to perform surgical resection.

Original languageEnglish
JournalEuropean Journal of Surgical Oncology
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Pancreatic Neoplasms
Neoplasm Metastasis
Biopsy
Liver
Neoplasms

Keywords

  • Cytology
  • Grading
  • Ki-67
  • Liver metastases
  • Neuroendocrine tumor (NET)
  • Pancreas
  • Proliferation index

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{6e56a14b7916432aba769d81a1ccdf81,
title = "Ki-67 and presence of liver metastases identify different progression-risk classes in pancreatic neuroendocrine neoplasms (pNEN) undergoing resection",
abstract = "In pancreatic neuroendocrine neoplasms (pNEN), size ≤2 cm and Ki-67 < 3{\%} suggest indolent behavior, but no factor alone predicts prognosis. We investigated factors predictive of tumor progression in 80 pNENs surgically resected in a single Institution from 1995 to 2015. At multivariable analysis the only two independent variables related to PFS were Ki-67 (HR 2.97; 95{\%}CI 1.26–7.02) and presence of synchronous liver metastases (HR 3.60; 95{\%}CI 1.70–7.61). Using Ki-67 < 3{\%} and M0 as reference, the HR for tumor progression was 3.21 (95{\%}CI 1.18–8.74) for M0 patients with Ki-67 3–20{\%}, 5.06 (2.29–11.2) for M1 patients with Ki-67 ≤ 20{\%} and 24.3 (6.64–89.2) for those with Ki-67 > 20{\%}. Tumor size (≤2 vs. >2 cm) was not a predictive factor at any analysis. Intra-class correlation of Ki-67 values on pre-surgical biopsies vs. surgical specimens was 0.99 and Ki-67 classes were correctly identified in 97{\%} of biopsies. Ki-67 and presence of liver metastases are the major prognostic factors in pNEN and identify different progression risks regardless of tumor size. Pre-surgical pNEN biopsy for Ki-67 assessment should be included in the evaluation of patients with 1–2 cm tumors to help in the decision on whether to perform surgical resection.",
keywords = "Cytology, Grading, Ki-67, Liver metastases, Neuroendocrine tumor (NET), Pancreas, Proliferation index",
author = "Massimo Milione and Patrick Maisonneuve and Alessio Pellegrinelli and Paola Spaggiari and Giovanni Centonze and Jorgelina Coppa and Gabriele Delconte and {Droz dit Busset}, Michele and Oleksandra Lanhazo and Giancarlo Pruneri and Vincenzo Mazzaferro",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.ejso.2018.10.052",
language = "English",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "W.B. Saunders Ltd",

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TY - JOUR

T1 - Ki-67 and presence of liver metastases identify different progression-risk classes in pancreatic neuroendocrine neoplasms (pNEN) undergoing resection

AU - Milione, Massimo

AU - Maisonneuve, Patrick

AU - Pellegrinelli, Alessio

AU - Spaggiari, Paola

AU - Centonze, Giovanni

AU - Coppa, Jorgelina

AU - Delconte, Gabriele

AU - Droz dit Busset, Michele

AU - Lanhazo, Oleksandra

AU - Pruneri, Giancarlo

AU - Mazzaferro, Vincenzo

PY - 2018/1/1

Y1 - 2018/1/1

N2 - In pancreatic neuroendocrine neoplasms (pNEN), size ≤2 cm and Ki-67 < 3% suggest indolent behavior, but no factor alone predicts prognosis. We investigated factors predictive of tumor progression in 80 pNENs surgically resected in a single Institution from 1995 to 2015. At multivariable analysis the only two independent variables related to PFS were Ki-67 (HR 2.97; 95%CI 1.26–7.02) and presence of synchronous liver metastases (HR 3.60; 95%CI 1.70–7.61). Using Ki-67 < 3% and M0 as reference, the HR for tumor progression was 3.21 (95%CI 1.18–8.74) for M0 patients with Ki-67 3–20%, 5.06 (2.29–11.2) for M1 patients with Ki-67 ≤ 20% and 24.3 (6.64–89.2) for those with Ki-67 > 20%. Tumor size (≤2 vs. >2 cm) was not a predictive factor at any analysis. Intra-class correlation of Ki-67 values on pre-surgical biopsies vs. surgical specimens was 0.99 and Ki-67 classes were correctly identified in 97% of biopsies. Ki-67 and presence of liver metastases are the major prognostic factors in pNEN and identify different progression risks regardless of tumor size. Pre-surgical pNEN biopsy for Ki-67 assessment should be included in the evaluation of patients with 1–2 cm tumors to help in the decision on whether to perform surgical resection.

AB - In pancreatic neuroendocrine neoplasms (pNEN), size ≤2 cm and Ki-67 < 3% suggest indolent behavior, but no factor alone predicts prognosis. We investigated factors predictive of tumor progression in 80 pNENs surgically resected in a single Institution from 1995 to 2015. At multivariable analysis the only two independent variables related to PFS were Ki-67 (HR 2.97; 95%CI 1.26–7.02) and presence of synchronous liver metastases (HR 3.60; 95%CI 1.70–7.61). Using Ki-67 < 3% and M0 as reference, the HR for tumor progression was 3.21 (95%CI 1.18–8.74) for M0 patients with Ki-67 3–20%, 5.06 (2.29–11.2) for M1 patients with Ki-67 ≤ 20% and 24.3 (6.64–89.2) for those with Ki-67 > 20%. Tumor size (≤2 vs. >2 cm) was not a predictive factor at any analysis. Intra-class correlation of Ki-67 values on pre-surgical biopsies vs. surgical specimens was 0.99 and Ki-67 classes were correctly identified in 97% of biopsies. Ki-67 and presence of liver metastases are the major prognostic factors in pNEN and identify different progression risks regardless of tumor size. Pre-surgical pNEN biopsy for Ki-67 assessment should be included in the evaluation of patients with 1–2 cm tumors to help in the decision on whether to perform surgical resection.

KW - Cytology

KW - Grading

KW - Ki-67

KW - Liver metastases

KW - Neuroendocrine tumor (NET)

KW - Pancreas

KW - Proliferation index

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U2 - 10.1016/j.ejso.2018.10.052

DO - 10.1016/j.ejso.2018.10.052

M3 - Article

AN - SCOPUS:85055129301

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

ER -