Pattern and Clinical Predictors of Lymph Node Involvement in Nonfunctioning Pancreatic Neuroendocrine Tumors (NF-PanNETs)

Stefano Partelli, Sebastien Gaujoux, Letizia Boninsegna, Rim Cherif, Stefano Crippa, Anne Couvelard, Aldo Scarpa, Philippe Ruszniewski, Alain Sauvanet, Massimo Falconi

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Abstract

IMPORTANCE Nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) are often indolent neoplasms without lymph node (LN) metastasis at diagnosis. Therefore, in patients with low risk of LN metastasis, the extent of surgery and lymphadenectomy could be limited and follow-up adjusted to the very low risk of relapse. OBJECTIVE To construct a predicting model to assess the risk of pN+ prior to surgical resection for NF-PanNETs using preoperative retrievable variables. DESIGN Retrospective review using multiple logistic regression analysis to construct predictive model of pN+ based on preoperatively available data. SETTING The combined prospective databases of the Surgical Departments of the University of Verona, Verona, Italy, and Beaujon Hospital, Clichy, France, were queried for clinical and pathological data. PARTICIPANTS All patients with resected (R0 or R1), pathologically confirmed NF-PanNETs between January 1, 1993 and December 31, 2009. MAIN OUTCOME AND MEASURE Risk of lymph node metastases in patients with pancreatic neuroendocrine tumors. RESULTS Among 181 patients, nodal metastases were reported in 55 patients (30%) and were associated with decreased 5-year disease-free survival (70% vs 97%, P <.001). Multivariable analysis showed that independent factors associated with nodal metastasis were radiological nodal status (rN) (odds ratio [OR], 5.58; P <.001) and tumor grade (NET-G2 vs NET-G1: OR, 4.87; P <.001) (first model). When the tumor grade was excluded, rN (OR, 4.73; P = .001) and radiological tumor size larger than 4 cm(OR, 2.67; P = .03) were independent predictors of nodal metastasis (second model). The area under the receiver operating characteristic curve for the first and second models were 80% and 74%, respectively. CONCLUSIONS AND RELEVANCE Patients with NF-PanNET-G1 have a very low risk of pN+ in the absence of radiological signs of node involvement. When preoperative grading assessment is not achieved, the radiological size of the lesion is a powerful alternative predictor of pN+. The risk of pathological nodal involvement in patients with NF-PanNETs can be accurately estimated by a clinical predictive model.

Original languageEnglish
Pages (from-to)932-939
Number of pages8
JournalJAMA Surgery
Volume148
Issue number10
DOIs
Publication statusPublished - Oct 2013

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Neuroendocrine Tumors
Lymph Nodes
Neoplasm Metastasis
Odds Ratio
Neoplasms
Lymph Node Excision
ROC Curve
Italy
Disease-Free Survival
France
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Databases
Recurrence

ASJC Scopus subject areas

  • Surgery

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Pattern and Clinical Predictors of Lymph Node Involvement in Nonfunctioning Pancreatic Neuroendocrine Tumors (NF-PanNETs). / Partelli, Stefano; Gaujoux, Sebastien; Boninsegna, Letizia; Cherif, Rim; Crippa, Stefano; Couvelard, Anne; Scarpa, Aldo; Ruszniewski, Philippe; Sauvanet, Alain; Falconi, Massimo.

In: JAMA Surgery, Vol. 148, No. 10, 10.2013, p. 932-939.

Research output: Contribution to journalArticle

Partelli, S, Gaujoux, S, Boninsegna, L, Cherif, R, Crippa, S, Couvelard, A, Scarpa, A, Ruszniewski, P, Sauvanet, A & Falconi, M 2013, 'Pattern and Clinical Predictors of Lymph Node Involvement in Nonfunctioning Pancreatic Neuroendocrine Tumors (NF-PanNETs)', JAMA Surgery, vol. 148, no. 10, pp. 932-939. https://doi.org/10.1001/jamasurg.2013.3376
Partelli, Stefano ; Gaujoux, Sebastien ; Boninsegna, Letizia ; Cherif, Rim ; Crippa, Stefano ; Couvelard, Anne ; Scarpa, Aldo ; Ruszniewski, Philippe ; Sauvanet, Alain ; Falconi, Massimo. / Pattern and Clinical Predictors of Lymph Node Involvement in Nonfunctioning Pancreatic Neuroendocrine Tumors (NF-PanNETs). In: JAMA Surgery. 2013 ; Vol. 148, No. 10. pp. 932-939.
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abstract = "IMPORTANCE Nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) are often indolent neoplasms without lymph node (LN) metastasis at diagnosis. Therefore, in patients with low risk of LN metastasis, the extent of surgery and lymphadenectomy could be limited and follow-up adjusted to the very low risk of relapse. OBJECTIVE To construct a predicting model to assess the risk of pN+ prior to surgical resection for NF-PanNETs using preoperative retrievable variables. DESIGN Retrospective review using multiple logistic regression analysis to construct predictive model of pN+ based on preoperatively available data. SETTING The combined prospective databases of the Surgical Departments of the University of Verona, Verona, Italy, and Beaujon Hospital, Clichy, France, were queried for clinical and pathological data. PARTICIPANTS All patients with resected (R0 or R1), pathologically confirmed NF-PanNETs between January 1, 1993 and December 31, 2009. MAIN OUTCOME AND MEASURE Risk of lymph node metastases in patients with pancreatic neuroendocrine tumors. RESULTS Among 181 patients, nodal metastases were reported in 55 patients (30{\%}) and were associated with decreased 5-year disease-free survival (70{\%} vs 97{\%}, P <.001). Multivariable analysis showed that independent factors associated with nodal metastasis were radiological nodal status (rN) (odds ratio [OR], 5.58; P <.001) and tumor grade (NET-G2 vs NET-G1: OR, 4.87; P <.001) (first model). When the tumor grade was excluded, rN (OR, 4.73; P = .001) and radiological tumor size larger than 4 cm(OR, 2.67; P = .03) were independent predictors of nodal metastasis (second model). The area under the receiver operating characteristic curve for the first and second models were 80{\%} and 74{\%}, respectively. CONCLUSIONS AND RELEVANCE Patients with NF-PanNET-G1 have a very low risk of pN+ in the absence of radiological signs of node involvement. When preoperative grading assessment is not achieved, the radiological size of the lesion is a powerful alternative predictor of pN+. The risk of pathological nodal involvement in patients with NF-PanNETs can be accurately estimated by a clinical predictive model.",
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AU - Gaujoux, Sebastien

AU - Boninsegna, Letizia

AU - Cherif, Rim

AU - Crippa, Stefano

AU - Couvelard, Anne

AU - Scarpa, Aldo

AU - Ruszniewski, Philippe

AU - Sauvanet, Alain

AU - Falconi, Massimo

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N2 - IMPORTANCE Nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) are often indolent neoplasms without lymph node (LN) metastasis at diagnosis. Therefore, in patients with low risk of LN metastasis, the extent of surgery and lymphadenectomy could be limited and follow-up adjusted to the very low risk of relapse. OBJECTIVE To construct a predicting model to assess the risk of pN+ prior to surgical resection for NF-PanNETs using preoperative retrievable variables. DESIGN Retrospective review using multiple logistic regression analysis to construct predictive model of pN+ based on preoperatively available data. SETTING The combined prospective databases of the Surgical Departments of the University of Verona, Verona, Italy, and Beaujon Hospital, Clichy, France, were queried for clinical and pathological data. PARTICIPANTS All patients with resected (R0 or R1), pathologically confirmed NF-PanNETs between January 1, 1993 and December 31, 2009. MAIN OUTCOME AND MEASURE Risk of lymph node metastases in patients with pancreatic neuroendocrine tumors. RESULTS Among 181 patients, nodal metastases were reported in 55 patients (30%) and were associated with decreased 5-year disease-free survival (70% vs 97%, P <.001). Multivariable analysis showed that independent factors associated with nodal metastasis were radiological nodal status (rN) (odds ratio [OR], 5.58; P <.001) and tumor grade (NET-G2 vs NET-G1: OR, 4.87; P <.001) (first model). When the tumor grade was excluded, rN (OR, 4.73; P = .001) and radiological tumor size larger than 4 cm(OR, 2.67; P = .03) were independent predictors of nodal metastasis (second model). The area under the receiver operating characteristic curve for the first and second models were 80% and 74%, respectively. CONCLUSIONS AND RELEVANCE Patients with NF-PanNET-G1 have a very low risk of pN+ in the absence of radiological signs of node involvement. When preoperative grading assessment is not achieved, the radiological size of the lesion is a powerful alternative predictor of pN+. The risk of pathological nodal involvement in patients with NF-PanNETs can be accurately estimated by a clinical predictive model.

AB - IMPORTANCE Nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) are often indolent neoplasms without lymph node (LN) metastasis at diagnosis. Therefore, in patients with low risk of LN metastasis, the extent of surgery and lymphadenectomy could be limited and follow-up adjusted to the very low risk of relapse. OBJECTIVE To construct a predicting model to assess the risk of pN+ prior to surgical resection for NF-PanNETs using preoperative retrievable variables. DESIGN Retrospective review using multiple logistic regression analysis to construct predictive model of pN+ based on preoperatively available data. SETTING The combined prospective databases of the Surgical Departments of the University of Verona, Verona, Italy, and Beaujon Hospital, Clichy, France, were queried for clinical and pathological data. PARTICIPANTS All patients with resected (R0 or R1), pathologically confirmed NF-PanNETs between January 1, 1993 and December 31, 2009. MAIN OUTCOME AND MEASURE Risk of lymph node metastases in patients with pancreatic neuroendocrine tumors. RESULTS Among 181 patients, nodal metastases were reported in 55 patients (30%) and were associated with decreased 5-year disease-free survival (70% vs 97%, P <.001). Multivariable analysis showed that independent factors associated with nodal metastasis were radiological nodal status (rN) (odds ratio [OR], 5.58; P <.001) and tumor grade (NET-G2 vs NET-G1: OR, 4.87; P <.001) (first model). When the tumor grade was excluded, rN (OR, 4.73; P = .001) and radiological tumor size larger than 4 cm(OR, 2.67; P = .03) were independent predictors of nodal metastasis (second model). The area under the receiver operating characteristic curve for the first and second models were 80% and 74%, respectively. CONCLUSIONS AND RELEVANCE Patients with NF-PanNET-G1 have a very low risk of pN+ in the absence of radiological signs of node involvement. When preoperative grading assessment is not achieved, the radiological size of the lesion is a powerful alternative predictor of pN+. The risk of pathological nodal involvement in patients with NF-PanNETs can be accurately estimated by a clinical predictive model.

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