Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Fate of Surgical Patients with Small Nonfunctioning Pancreatic Neuroendocrine Tumors: An International Study Using Multi-Institutional Registries

Version 1 : Received: 22 July 2021 / Approved: 23 July 2021 / Online: 23 July 2021 (08:07:47 CEST)

How to cite: Han, I.W.; Park, J.; Park, E.Y.; Yoon, S.J.; Jin, G.; Hwang, D.W.; Jiang, K.; Kwon, W.; Xu, X.; Heo, J.S.; Fu, D.; Lee, W.; Bai, X.; Yoon, Y.; Yang, Y.; Ahn, K.S.; Yuan, C.; Lee, H.K.; Sun, B.; Park, E.K.; Lee, S.E.; Kang, S.; Lou, W.H.; Park, S. Fate of Surgical Patients with Small Nonfunctioning Pancreatic Neuroendocrine Tumors: An International Study Using Multi-Institutional Registries. Preprints 2021, 2021070527 (doi: 10.20944/preprints202107.0527.v1). Han, I.W.; Park, J.; Park, E.Y.; Yoon, S.J.; Jin, G.; Hwang, D.W.; Jiang, K.; Kwon, W.; Xu, X.; Heo, J.S.; Fu, D.; Lee, W.; Bai, X.; Yoon, Y.; Yang, Y.; Ahn, K.S.; Yuan, C.; Lee, H.K.; Sun, B.; Park, E.K.; Lee, S.E.; Kang, S.; Lou, W.H.; Park, S. Fate of Surgical Patients with Small Nonfunctioning Pancreatic Neuroendocrine Tumors: An International Study Using Multi-Institutional Registries. Preprints 2021, 2021070527 (doi: 10.20944/preprints202107.0527.v1).

Abstract

Several treatment guidelines for sporadic, nonmetastatic nonfunctioning neuroendocrine tumors of the pancreas (NF-pNETs) have recommended resection, however, tumors ≤ 2 cm do not necessarily need surgery. This study aimed to establish a surgical treatment plan for NF-pNETs ≤ 2 cm. From 2000 to 2017, 483 patients who underwent resection for NF-pNETs ≤ 2cm in 18 institutions from Korea and China were enrolled and their medical records were reviewed. Median age was 56 (range 16- 80) years. The 10-year overall survival rate (10Y-OS) and recurrence-free survival rate (10Y-RFS) were 89.8 and 93.1%, respectively. In multivariable analysis, tumor size (> 1.5cm; p = 0.001) and nodal metastasis (p = 0.013) were independent adverse prognostic factors for OS. Perineural invasion (p = 0.008) and high Ki-67 index (≥3%; p < 0.001) were independent prognostic factors for poor RFS. NF-pNETs ≤ 2 cm showed unfavorable prognosis after resection when the tumor was larger than 1.5cm, Ki-67 index ≥ 3%, or nodal metastasis was present. NF-pNET patients with tumors ≤ 1.5cm can be observed if the preoperative Ki-67 index is under 3%, and if nodal metastasis is not suspected in preoperative radiologic studies. These findings support the clinical use to make decision about small NF-pNETs.

Keywords

Nonfunctioning neuroendocrine tumor of pancreas; Prognosis; Resection; Risk factors

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