Skip to main content
SpringerLink
Log in

Exploration of the Exact Prognostic Significance of Lymphatic Metastasis in Jejunoileal Neuroendocrine Tumors

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

How to evaluate the prognostic significance of lymphatic metastasis in patients with small bowel (jejunoileal) neuroendocrine tumors (SBNETs) is still not conclusive.

Methods

Data for patients with SBNETs, but without distant metastasis, were retrieved from the Surveillance, Epidemiology, and End Results database. Recursive partitioning analysis (RPA) was used for classification development by combining examined lymph nodes (ELNs) and lymph node ratio (LNR).

Results

Overall, 1925 patient records were retrieved. Patients with N0 and N1 disease (based on the definition of the European Neuroendocrine Tumor Society [ENETS] staging classification) did not have different OS (p = 0.7867), nor did patients with N0, N1 (< 12 positive nodes), and N2 (≥ 12 positive nodes) disease based on the definition of American Joint Committee on Cancer (AJCC) 8th edition staging classification (p = 0.5276). However, Cox regression analysis indicated that both ELNs (hazard ratio [HR] 0.968, 95% confidence interval [CI] 0.949–0.987; p = 0.0013) and LNR (HR 2.288, 95% CI 1.122–3.682; p = 0.0006) were prognostic factors. Using RPA, we combined ELNs and LNR, and patients were reclassified into three groups (group 1: ELNs ≥ 12, any LNR; group 2: ELNs < 12, LNR < 0.35; group 3: ELNs < 12, LNR ≥ 0.35). Survival analysis and multivariate Cox regression showed that groups 1, 2, and 3 had progressively worse survival. Furthermore, we found that ELNs ≥ 12 could remarkably improve patient survival (p < 0.001).

Conclusions

The current definition of lymphatic metastasis could not help predict patient survival. Our newly proposed classification of lymphatic metastasis is better than the ENETS and AJCC 8th edition staging classifications in evaluating the prognostic significance of lymphatic metastasis in SBNETs. Systematic resection of lymph nodes (≥ 12) could help improve patient survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Dasari A, Shen C, Halperin D, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 2017;3(10):1335–1342.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chen L, Zhou L, Zhang M, et al. Clinicopathological features and prognostic validity of WHO grading classification of SI-NENs. BMC Cancer. 2017;17(1):521.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Howe JR, Cardona K, Fraker DL, et al. The surgical management of small bowel neuroendocrine tumors: consensus guidelines of the North American Neuroendocrine Tumor Society. Pancreas. 2017;46(6):715–731.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Partelli S, Bartsch DK, Capdevila J, et al. ENETS consensus guidelines for standard of care in neuroendocrine tumours: surgery for small intestinal and pancreatic neuroendocrine tumours. Neuroendocrinology. 2017;105(3):255–265.

    Article  PubMed  CAS  Google Scholar 

  5. Rindi G, Kloppel G, Couvelard A, et al. TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch. 2007;451(4):757–762.

    Article  PubMed  CAS  Google Scholar 

  6. Strosberg JR, Weber JM, Feldman M, Coppola D, Meredith K, Kvols LK. Prognostic validity of the American Joint Committee on Cancer staging classification for midgut neuroendocrine tumors. J Clin Oncol. 2013;31(4):420–425.

    Article  PubMed  Google Scholar 

  7. Amin MB, Edge SB, Greene FL, et al. AJCC cancer staging manual. 8th ed. New York: Springer; 2016.

    Google Scholar 

  8. Landry CS, Lin HY, Phan A, et al. Resection of at-risk mesenteric lymph nodes is associated with improved survival in patients with small bowel neuroendocrine tumors. World J Surg. 2013;37(7):1695–1700.

    Article  PubMed  Google Scholar 

  9. Kim MK, Warner RR, Ward SC, et al. Prognostic significance of lymph node metastases in small intestinal neuroendocrine tumors. Neuroendocrinology. 2015;101(1):58–65.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Pasquer A, Walter T, Hervieu V, et al. Surgical management of small bowel neuroendocrine tumors: specific requirements and their impact on staging and prognosis. Ann Surg Oncol. 2015;22(Suppl 3):742–749.

    Article  Google Scholar 

  11. Norlen O, Stalberg P, Oberg K, et al. Long-term results of surgery for small intestinal neuroendocrine tumors at a tertiary referral center. World J Surg. 2012;36(6):1419–1431.

    Article  PubMed  Google Scholar 

  12. Fata CR, Gonzalez RS, Liu E, Cates JM, Shi C. Mesenteric tumor deposits in midgut small intestinal neuroendocrine tumors are a stronger indicator than lymph node metastasis for liver metastasis and poor prognosis. Am J Surg Pathol. 2017;41(1):128–133.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Valsangkar NP, Bush DM, Michaelson JS, et al. N0/N1, PNL, or LNR? The effect of lymph node number on accurate survival prediction in pancreatic ductal adenocarcinoma. J Gastrointest Surg. 2013;17(2):257–266.

    Article  PubMed  Google Scholar 

  14. Lee HY, Choi HJ, Park KJ, et al. Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma. Ann Surg Oncol. 2007;14(5):1712–1717.

    Article  PubMed  Google Scholar 

  15. Strosberg J. Neuroendocrine tumours of the small intestine. Best Pract Res Clin Gastroenterol. 2012;26(6):755–773.

    Article  CAS  Google Scholar 

Download references

Funding

This research was supported by the Guangzhou Science and Technology Plan (201804010078).

Disclosure

Luohai Chen, Yunda Song, Yu Zhang, Minhu Chen, and Jie Chen have no personal conflicts of interest in relation to this study.

Author information

Author notes

  1. Luohai Chen, Yunda Song, and Yu Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Luohai Chen, Yu Zhang, Minhu Chen & Jie Chen

  2. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China

    Yunda Song

  3. Department of Hepatobiliary and Pancreatic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China

    Yunda Song

Authors
  1. Luohai Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yunda Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Minhu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jie Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Minhu Chen or Jie Chen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, L., Song, Y., Zhang, Y. et al. Exploration of the Exact Prognostic Significance of Lymphatic Metastasis in Jejunoileal Neuroendocrine Tumors. Ann Surg Oncol 25, 2067–2074 (2018). https://doi.org/10.1245/s10434-018-6511-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6511-9

Keywords

Search

Navigation