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

Massimo Milione, Patrick Maisonneuve, Alessio Pellegrinelli, Paola Spaggiari, Giovanni Centonze, Jorgelina Coppa, Gabriele Delconte, Michele Droz dit Busset, Oleksandra Lanhazo, Giancarlo Pruneri, Vincenzo Mazzaferro

Research output: Contribution to journalArticlepeer-review

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

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Oncology

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