Observational study of natural history of small sporadic nonfunctioning pancreatic neuroendocrine tumors

Sébastien Gaujoux, Stefano Partelli, Frédérique Maire, Mirko D'Onofrio, Béatrice Larroque, Domenico Tamburrino, Alain Sauvanet, Massimo Falconi, Philippe Ruszniewski

Research output: Contribution to journalArticlepeer-review

Abstract

Context: Asymptomatic sporadic nonfunctioning, well-differentiated pancreatic neuroendocrine tumors (NF-PNETs) are increasingly diagnosed, and their management is controversial because of their overall good but heterogeneous prognosis. Objective: The objective of the study was to assess the natural history of asymptomatic sporadic NF-PNETs smaller than 2 cm in size and the risk-benefit balance of nonoperative management. Experimental Design: From January 2000 to June 2011, 46 patients with proven asymptomatic sporadic NF-PNETs smaller than 2 cm in size were followed up for at least 18 months with serial imaging in tertiary referral centers. Results: Patientsweremainlyfemale(65%),withamedianageof60years.Tumorsweremainlylocated in the pancreatic head (52%), with a median lesion size of 13 mm (range 9-15). After a median follow-up of 34 months (range 24-52) and an average of four (range 3-6) serial imaging sessions, distant or nodal metastases appeared on the imaging in none of the patients. In six patients (13%), a 20%or greater increase in sizewasobserved. Overall median tumor growthwas0.12mmper year,and neither patients nor tumor characteristics were found to be significant predictors of tumor growth. Overall, eight patients (17%) underwent surgery after a median time from initial evaluation of 41 months(range 27-58); all resected lesionswereEuropeanNeuroendocrineTumorSocietyTstage1(n=7) or 2 (n = 1), grade 1, node negative, with neither vascular nor peripancreatic fat invasion. Conclusions: In selected patients, nonoperative management of asymptomatic sporadic NF-PNETs smaller than 2 cmin size is safe. Larger and prospective multicentric studies with long-term follow-up are now needed to validate this wait-and-see policy.

Original languageEnglish
Pages (from-to)4784-4789
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Volume98
Issue number12
DOIs
Publication statusPublished - Dec 2013

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

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