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Erschienen in: Annals of Surgical Oncology 4/2016

01.04.2016 | Pancreatic Tumors

Observation versus Resection for Small Asymptomatic Pancreatic Neuroendocrine Tumors: A Matched Case–Control Study

verfasst von: MD Eran Sadot, MD Diane L. Reidy-Lagunes, MD, PhD Laura H. Tang, MD, PhD Richard Kinh Gian Do, PhD Mithat Gonen, MD Michael I. D’Angelica, MD Ronald P. DeMatteo, MD T. Peter Kingham, MD Bas Groot Koerkamp, MD Brian R. Untch, MD Murray F. Brennan, MD William R. Jarnagin, MD Peter J. Allen

Erschienen in: Annals of Surgical Oncology | Ausgabe 4/2016

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Abstract

Objective

To analyze the natural history of small asymptomatic pancreatic neuroendocrine tumors (PanNET) and to present a matched comparison between groups who underwent either initial observation or resection. Management approach for small PanNET is uncertain.

Methods

Incidentally discovered, sporadic, small (<3 cm), stage I–II PanNET were analyzed retrospectively between 1993 and 2013. Diagnosis was determined either by pathology or imaging characteristics. Intention-to-treat analysis was applied.

Results

A total of 464 patients were reviewed. Observation was recommended for 104 patients (observation group), and these patients were matched to 77 patients in the resection group based on tumor size at initial imaging. The observation group was significantly older (median 63 vs. 59 years, p = 0.04) and tended towards shorter follow-up (44 vs. 57 months, p = 0.06). Within the observation group, 26 of the 104 patients (25 %) underwent subsequent tumor resection after a median observation interval of 30 months (range 7–135). At the time of last follow-up of the observation group, the median tumor size had not changed (1.2 cm, p = 0.7), and no patient had developed evidence of metastases. Within the resection group, low-grade (G1) pathology was recorded in 72 (95 %) tumors and 5 (6 %) developed a recurrence, which occurred after a median of 5.1 (range 2.9–8.1) years. No patient in either group died from disease. Death from other causes occurred in 11 of 181 (6 %) patients.

Conclusions

In this study, no patient who was initially observed developed metastases or died from disease after a median follow-up of 44 months. Observation for stable, small, incidentally discovered PanNET is reasonable in selected patients.
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Literatur
1.
2.
Zurück zum Zitat Dartmouth Atlas of Health Care. The Dartmouth Institute for health policy and clinical practice.Raleigh: Lulu; 2008 Dartmouth Atlas of Health Care. The Dartmouth Institute for health policy and clinical practice.Raleigh: Lulu; 2008
3.
Zurück zum Zitat Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320–8. CrossRefPubMed Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320–8. CrossRefPubMed
4.
Zurück zum Zitat Welch HG, Schwartz LM, Woloshin S. Ramifications of screening for breast cancer: 1 in 4 cancers detected by mammography are pseudocancers. BMJ (Clin Res ed.). 2006;332(7543):727. CrossRef Welch HG, Schwartz LM, Woloshin S. Ramifications of screening for breast cancer: 1 in 4 cancers detected by mammography are pseudocancers. BMJ (Clin Res ed.). 2006;332(7543):727. CrossRef
5.
Zurück zum Zitat Marcus PM, Bergstralh EJ, Zweig MH, Harris A, Offord KP, Fontana RS. Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis. J Natl Cancer Inst. 2006;98(11):748–56. CrossRefPubMed Marcus PM, Bergstralh EJ, Zweig MH, Harris A, Offord KP, Fontana RS. Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis. J Natl Cancer Inst. 2006;98(11):748–56. CrossRefPubMed
6.
Zurück zum Zitat Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006;295(18):2164–7. CrossRefPubMed Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006;295(18):2164–7. CrossRefPubMed
7.
Zurück zum Zitat Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”: screening and overdiagnosis. N Engl J Med. 2014;371(19):1765–7. CrossRefPubMed Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”: screening and overdiagnosis. N Engl J Med. 2014;371(19):1765–7. CrossRefPubMed
8.
Zurück zum Zitat Welch HG, Woloshin S, Schwartz LM. Skin biopsy rates and incidence of melanoma: population based ecological study. BMJ (Clin Res ed.). 2005;331(7515):481. CrossRef Welch HG, Woloshin S, Schwartz LM. Skin biopsy rates and incidence of melanoma: population based ecological study. BMJ (Clin Res ed.). 2005;331(7515):481. CrossRef
9.
Zurück zum Zitat Zhang J, Kang SK, Wang L, Touijer A, Hricak H. Distribution of renal tumor growth rates determined by using serial volumetric CT measurements. Radiology. 2009;250(1):137–44. CrossRefPubMed Zhang J, Kang SK, Wang L, Touijer A, Hricak H. Distribution of renal tumor growth rates determined by using serial volumetric CT measurements. Radiology. 2009;250(1):137–44. CrossRefPubMed
10.
Zurück zum Zitat Gaujoux S, Brennan MF, Gonen M, et al. Cystic lesions of the pancreas: changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period. J Am Coll Surg. 2011;212(4):590–600. CrossRefPubMed Gaujoux S, Brennan MF, Gonen M, et al. Cystic lesions of the pancreas: changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period. J Am Coll Surg. 2011;212(4):590–600. CrossRefPubMed
11.
Zurück zum Zitat Verbeke C, Caroline SV, Fiona C. Pathology of the pancreas: a practical approach. New York:Springer Verlag; 2013. Verbeke C, Caroline SV, Fiona C. Pathology of the pancreas: a practical approach. New York:Springer Verlag; 2013.
12.
Zurück zum Zitat Grimelius L, Hultquist GT, Stenkvist B. Cytological differentiation of asymptomatic pancreatic islet cell tumours in autopsy material. Virch Archiv A Pathol Anat Histol. 1975;365(4):275–88. CrossRef Grimelius L, Hultquist GT, Stenkvist B. Cytological differentiation of asymptomatic pancreatic islet cell tumours in autopsy material. Virch Archiv A Pathol Anat Histol. 1975;365(4):275–88. CrossRef
13.
Zurück zum Zitat Kimura W, Kuroda A, Morioka Y. Clinical pathology of endocrine tumors of the pancreas. Analysis of autopsy cases. Dig Dis Sci. 1991;36(7):933–42. CrossRefPubMed Kimura W, Kuroda A, Morioka Y. Clinical pathology of endocrine tumors of the pancreas. Analysis of autopsy cases. Dig Dis Sci. 1991;36(7):933–42. CrossRefPubMed
14.
Zurück zum Zitat Klimstra DS, Perren A, Oberg K, et al. Pancreatic endocrine tumors: non-functioning tumors and microadenomas. In: DeLellis RA, Lloyd RV, Heitz PU, et al., eds. Pathology and genetics of tumours of endocrine origin. Lyon, France: IARC Press; 2004:201–4. Klimstra DS, Perren A, Oberg K, et al. Pancreatic endocrine tumors: non-functioning tumors and microadenomas. In: DeLellis RA, Lloyd RV, Heitz PU, et al., eds. Pathology and genetics of tumours of endocrine origin. Lyon, France: IARC Press; 2004:201–4.
15.
Zurück zum Zitat Kuo EJ, Salem RR. Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size. Ann Surg Oncol. 2013;20(9):2815–21. CrossRefPubMed Kuo EJ, Salem RR. Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size. Ann Surg Oncol. 2013;20(9):2815–21. CrossRefPubMed
17.
Zurück zum Zitat Bosman FT, Carneiro F, Hruban RH, Theise ND. World Health Organization Classification of Tumours of the Digestive System. IARC, Lyon, 2010. Bosman FT, Carneiro F, Hruban RH, Theise ND. World Health Organization Classification of Tumours of the Digestive System. IARC, Lyon, 2010.
19.
Zurück zum Zitat Thompson NW, Lloyd RV, Nishiyama RH, et al. MEN I pancreas: a histological and immunohistochemical study. World J Surg. 1984;8(4):561–74. CrossRefPubMed Thompson NW, Lloyd RV, Nishiyama RH, et al. MEN I pancreas: a histological and immunohistochemical study. World J Surg. 1984;8(4):561–74. CrossRefPubMed
20.
Zurück zum Zitat Majewski JT, Wilson SD. The MEA-I syndrome: an all or none phenomenon? Surgery. 1979;86(3):475–84. PubMed Majewski JT, Wilson SD. The MEA-I syndrome: an all or none phenomenon? Surgery. 1979;86(3):475–84. PubMed
21.
Zurück zum Zitat Triponez F, Dosseh D, Goudet P, et al. Epidemiology data on 108 MEN 1 patients from the GTE with isolated nonfunctioning tumors of the pancreas. Ann Surg. 2006;243(2):265–72. CrossRefPubMedPubMedCentral Triponez F, Dosseh D, Goudet P, et al. Epidemiology data on 108 MEN 1 patients from the GTE with isolated nonfunctioning tumors of the pancreas. Ann Surg. 2006;243(2):265–72. CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Lee LC, Grant CS, Salomao DR, et al. Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs): role for nonoperative management. Surgery. 2012;152(6):965–74. CrossRefPubMed Lee LC, Grant CS, Salomao DR, et al. Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs): role for nonoperative management. Surgery. 2012;152(6):965–74. CrossRefPubMed
23.
Zurück zum Zitat Gaujoux S, Partelli S, Maire F, et al. Observational study of natural history of small sporadic nonfunctioning pancreatic neuroendocrine tumors. J Clin Endocrinol Metab. 2013;98(12):4784–9. CrossRefPubMed Gaujoux S, Partelli S, Maire F, et al. Observational study of natural history of small sporadic nonfunctioning pancreatic neuroendocrine tumors. J Clin Endocrinol Metab. 2013;98(12):4784–9. CrossRefPubMed
24.
Zurück zum Zitat Kendall DM, Sutherland DE, Najarian JS, Goetz FC, Robertson RP. Effects of hemipancreatectomy on insulin secretion and glucose tolerance in healthy humans. N Engl J Med. 1990;322(13):898–903. CrossRefPubMed Kendall DM, Sutherland DE, Najarian JS, Goetz FC, Robertson RP. Effects of hemipancreatectomy on insulin secretion and glucose tolerance in healthy humans. N Engl J Med. 1990;322(13):898–903. CrossRefPubMed
25.
Zurück zum Zitat Slezak LA, Andersen DK. Pancreatic resection: effects on glucose metabolism. World J Surg. 2001;25(4):452–60. CrossRefPubMed Slezak LA, Andersen DK. Pancreatic resection: effects on glucose metabolism. World J Surg. 2001;25(4):452–60. CrossRefPubMed
26.
Zurück zum Zitat Haynes AB, Deshpande V, Ingkakul T, et al. Implications of incidentally discovered, nonfunctioning pancreatic endocrine tumors: short-term and long-term patient outcomes. Arch Surg. 2011;146(5):534–8. CrossRefPubMedPubMedCentral Haynes AB, Deshpande V, Ingkakul T, et al. Implications of incidentally discovered, nonfunctioning pancreatic endocrine tumors: short-term and long-term patient outcomes. Arch Surg. 2011;146(5):534–8. CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Haigh PI, Bilimoria KY, DiFronzo LA. Early postoperative outcomes after pancreaticoduodenectomy in the elderly. Arch Surg. 2011;146(6):715–23. CrossRefPubMed Haigh PI, Bilimoria KY, DiFronzo LA. Early postoperative outcomes after pancreaticoduodenectomy in the elderly. Arch Surg. 2011;146(6):715–23. CrossRefPubMed
28.
Zurück zum Zitat Sukharamwala P, Thoens J, Szuchmacher M, Smith J, DeVito P. Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB. 2012;14(10):649–57. CrossRefPubMed Sukharamwala P, Thoens J, Szuchmacher M, Smith J, DeVito P. Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB. 2012;14(10):649–57. CrossRefPubMed
29.
Zurück zum Zitat Jiao Y, Shi C, Edil BH, et al. DAXX/ATRX, MEN1, and mTOR pathway genes are frequently altered in pancreatic neuroendocrine tumors. Science. 2011;331(6021):1199–203. CrossRefPubMedPubMedCentral Jiao Y, Shi C, Edil BH, et al. DAXX/ATRX, MEN1, and mTOR pathway genes are frequently altered in pancreatic neuroendocrine tumors. Science. 2011;331(6021):1199–203. CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Marinoni I, Kurrer AS, Vassella E, et al. Loss of DAXX and ATRX are associated with chromosome instability and reduced survival of patients with pancreatic neuroendocrine tumors. Gastroenterology. 2014;146(2):453–60.e455. CrossRefPubMed Marinoni I, Kurrer AS, Vassella E, et al. Loss of DAXX and ATRX are associated with chromosome instability and reduced survival of patients with pancreatic neuroendocrine tumors. Gastroenterology. 2014;146(2):453–60.e455. CrossRefPubMed
31.
Zurück zum Zitat Hill JS, McPhee JT, McDade TP, et al. Pancreatic neuroendocrine tumors: the impact of surgical resection on survival. Cancer. 2009;115(4):741–51. CrossRefPubMed Hill JS, McPhee JT, McDade TP, et al. Pancreatic neuroendocrine tumors: the impact of surgical resection on survival. Cancer. 2009;115(4):741–51. CrossRefPubMed
32.
Zurück zum Zitat Franko J, Feng W, Yip L, Genovese E, Moser AJ. Non-functional neuroendocrine carcinoma of the pancreas: incidence, tumor biology, and outcomes in 2,158 patients. J Gastrointest Surg. 2010;14(3):541–8. CrossRefPubMed Franko J, Feng W, Yip L, Genovese E, Moser AJ. Non-functional neuroendocrine carcinoma of the pancreas: incidence, tumor biology, and outcomes in 2,158 patients. J Gastrointest Surg. 2010;14(3):541–8. CrossRefPubMed
33.
Zurück zum Zitat Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg. 2007;204(3):356–64. CrossRefPubMed Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg. 2007;204(3):356–64. CrossRefPubMed
34.
Zurück zum Zitat DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244(6):931–7. CrossRefPubMedPubMedCentral DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244(6):931–7. CrossRefPubMedPubMedCentral
Metadaten
Titel
Observation versus Resection for Small Asymptomatic Pancreatic Neuroendocrine Tumors: A Matched Case–Control Study
verfasst von
MD Eran Sadot
MD Diane L. Reidy-Lagunes
MD, PhD Laura H. Tang
MD, PhD Richard Kinh Gian Do
PhD Mithat Gonen
MD Michael I. D’Angelica
MD Ronald P. DeMatteo
MD T. Peter Kingham
MD Bas Groot Koerkamp
MD Brian R. Untch
MD Murray F. Brennan
MD William R. Jarnagin
MD Peter J. Allen
Publikationsdatum
01.04.2016
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 4/2016
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4986-1

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