Elsevier

Surgery

Volume 152, Issue 1, July 2012, Pages 107-113
Surgery

Original Communication
Ki-67 predicts disease recurrence and poor prognosis in pancreatic neuroendocrine neoplasms

This work was presented in part at the 6th Academic Surgical Congress February, 2011.
https://doi.org/10.1016/j.surg.2012.02.011Get rights and content

Background

Pancreatic neuroendocrine neoplasms are rare malignancies for which the ideal staging method remains controversial. Ki-67 is a cell proliferation marker that has been shown to have some utility in predicting prognosis in neuroendocrine neoplasms. We sought to test the predictive ability of Ki-67 staining for disease recurrence and overall survival (OS) in pancreatic neuroendocrine neoplasms.

Methods

The medical records of patients who underwent pancreatic resection for pancreatic neuroendocrine neoplasms at a tertiary referral hospital from 1994 to 2009 were reviewed. The pathologic specimens of all were stained for Ki-67 and recorded as percentage of cells staining positive per high-powered field. The 10-year disease-free and OSs were analyzed.

Results

We identified 140 patients. Gender and age were not associated with increased risk of disease recurrence. Patients with tumors >4 cm or with Ki-67 staining >9% were more likely to have disease recurrence (P = .0454 and .047) and have decreased OS (P < .0001 and .0007).

Conclusion

Increasing tumor size and increasing Ki-67 staining both correlate with increased risk of disease recurrence and decreased OS. Designing a staging system that incorporates both of these clinical variables will enable better identification of patients at risk for recurrent pancreatic neuroendocrine neoplasms.

Section snippets

Methods

The medical records of patients with PNENs treated surgically at Barnes-Jewish Hospital/Washington University School of Medicine from 1994 to 2009 were retrospectively reviewed. Any patient with insufficient clinical follow-up or whose pathologic specimen did not allow for Ki-67 staining (too little tissue remaining) was excluded. Demographic data were collected, including gender, ethnicity, age at operation, location of tumor (proximal versus distal); type of operation (enucleation, Whipple

Results

From April 1, 1994, to April 1, 2009, 156 patients were treated surgically for PNENs. Complete medical records and tissue samples were available in 140. Sixteen (11.4%) patients were found to have stage IV disease at the time of operation and were excluded from primary analysis. Patient demographics can be found in Table I. Twenty-nine (20.7%) patients experienced recurrence of disease. Nineteen (13.6%) patients had known multiple endocrine neoplasia (MEN) type I syndrome and 22 (15.7%)

Discussion

The incidence of PNENs is increasing, probably in large part because of increased recognition of the disease. Many small tumors are identified incidentally because of increased utilization of cross-sectional imaging. The likelihood of finding small, nonfunctional PNENs is likely rising at a faster rate than that of functional PNENs. It may be that many of these small tumors in elderly individuals might never become symptomatic. Identifying risk factors and creating a prognostic staging system

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Funded by the Washington University Surgical Oncology Training Grant (NIH-5T32CA00962122), the Doug Phillips Fund for Pancreatic Cancer Research and the Siteman Cancer Center Support Grant (NIH-2P30CA09184209).

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