Margin status and long-term prognosis of primary pancreatic neuroendocrine tumor after curative resection: Results from the US Neuroendocrine Tumor Study Group.
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
24
04
2018
revised:
01
08
2018
accepted:
08
08
2018
pubmed:
4
10
2018
medline:
18
12
2019
entrez:
4
10
2018
Statut:
ppublish
Résumé
The impact of margin status on resection of primary pancreatic neuroendocrine tumors has been poorly defined. The objectives of the present study were to determine the impact of margin status on long-term survival of patients with pancreatic neuroendocrine tumors after curative resection and evaluate the impact of reresection to obtain a microscopically negative margin. Patients who underwent curative-intent resection for pancreatic neuroendocrine tumors between 2000 and 2016 were identified at 8 hepatobiliary centers. Overall and recurrence-free survival were analyzed relative to surgical margin status using univariable and multivariable analyses. Among 1,020 patients, 866 (84.9%) had an R0 (>1 mm margin) resection, whereas 154 (15.1%) had an R1 (≤1 mm margin) resection. R1 resection was associated with a worse recurrence-free survival (10-year recurrence-free survival, R1 47.3% vs R0 62.8%, hazard ratio 1.8, 95% confidence interval 1.2-2.7, P = .002); residual tumor at either the transection margin (R1t) or the mobilization margin (R1m) was associated with increased recurrence versus R0 (R1t versus R0: hazard ratio 1.8, 95% confidence interval 1.0-3.0, P = .033; R1m versus R0: hazard ratio 1.3, 95% confidence interval 1.0-1.7, P = .060). In contrast, margin status was not associated with overall survival (10-year overall survival, R1 71.1% vs R0 71.8%, P = .392). Intraoperatively, 539 (53.6%) patients had frozen section evaluation of the surgical margin; 49 (9.1%) patients had a positive margin on frozen section analysis; 38 of the 49 patients (77.6%) had reresection, and a final R0 (secondary R0) margin was achieved in 30 patients (78.9%). Extending resection to achieve an R0 status remained associated with worse overall survival (hazard ratio 3.1, 95% confidence interval 1.6-6.2, P = .001) and recurrence-free survival (hazard ratio 2.6, 95% confidence interval 1.4-5.0, P = .004) compared with primary R0 resection. On multivariable analyses, tumor-specific factors, such as cellular differentiation, perineural invasion, Ki-67 index, and major vascular invasion, rather than surgical margin, were associated with long-term outcomes. Margin status was not associated with long-term survival. The reresection of an initially positive surgical margin to achieve a negative margin did not improve the outcome of patients with pancreatic neuroendocrine tumors. Parenchymal-sparing pancreatic procedures for pancreatic neuroendocrine tumors may be appropriate when feasible.
Sections du résumé
BACKGROUND
The impact of margin status on resection of primary pancreatic neuroendocrine tumors has been poorly defined. The objectives of the present study were to determine the impact of margin status on long-term survival of patients with pancreatic neuroendocrine tumors after curative resection and evaluate the impact of reresection to obtain a microscopically negative margin.
METHODS
Patients who underwent curative-intent resection for pancreatic neuroendocrine tumors between 2000 and 2016 were identified at 8 hepatobiliary centers. Overall and recurrence-free survival were analyzed relative to surgical margin status using univariable and multivariable analyses.
RESULTS
Among 1,020 patients, 866 (84.9%) had an R0 (>1 mm margin) resection, whereas 154 (15.1%) had an R1 (≤1 mm margin) resection. R1 resection was associated with a worse recurrence-free survival (10-year recurrence-free survival, R1 47.3% vs R0 62.8%, hazard ratio 1.8, 95% confidence interval 1.2-2.7, P = .002); residual tumor at either the transection margin (R1t) or the mobilization margin (R1m) was associated with increased recurrence versus R0 (R1t versus R0: hazard ratio 1.8, 95% confidence interval 1.0-3.0, P = .033; R1m versus R0: hazard ratio 1.3, 95% confidence interval 1.0-1.7, P = .060). In contrast, margin status was not associated with overall survival (10-year overall survival, R1 71.1% vs R0 71.8%, P = .392). Intraoperatively, 539 (53.6%) patients had frozen section evaluation of the surgical margin; 49 (9.1%) patients had a positive margin on frozen section analysis; 38 of the 49 patients (77.6%) had reresection, and a final R0 (secondary R0) margin was achieved in 30 patients (78.9%). Extending resection to achieve an R0 status remained associated with worse overall survival (hazard ratio 3.1, 95% confidence interval 1.6-6.2, P = .001) and recurrence-free survival (hazard ratio 2.6, 95% confidence interval 1.4-5.0, P = .004) compared with primary R0 resection. On multivariable analyses, tumor-specific factors, such as cellular differentiation, perineural invasion, Ki-67 index, and major vascular invasion, rather than surgical margin, were associated with long-term outcomes.
CONCLUSION
Margin status was not associated with long-term survival. The reresection of an initially positive surgical margin to achieve a negative margin did not improve the outcome of patients with pancreatic neuroendocrine tumors. Parenchymal-sparing pancreatic procedures for pancreatic neuroendocrine tumors may be appropriate when feasible.
Identifiants
pubmed: 30278986
pii: S0039-6060(18)30525-7
doi: 10.1016/j.surg.2018.08.015
pmc: PMC10187058
mid: NIHMS1887072
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
548-556Subventions
Organisme : NCI NIH HHS
ID : K12 CA090625
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
Références
Surg Clin North Am. 2014 Jun;94(3):689-708
pubmed: 24857584
Ann Surg. 2001 Dec;234(6):758-68
pubmed: 11729382
Ann Surg. 2007 Jul;246(1):52-60
pubmed: 17592291
Ann Surg. 2018 Jun;267(6):1148-1154
pubmed: 28594340
Ann Surg. 2017 Jun;265(6):1219-1225
pubmed: 27280512
J Gastrointest Surg. 2013 Mar;17(3):511-21
pubmed: 23297028
Langenbecks Arch Surg. 2011 Dec;396(8):1197-203
pubmed: 21553230
Br J Cancer. 2017 Nov 7;117(10):1544-1550
pubmed: 28949958
J Gastrointest Surg. 2009 Sep;13(9):1692-8
pubmed: 19548038
Surg Clin North Am. 2013 Jun;93(3):647-62
pubmed: 23632150
Ann Surg Oncol. 2008 Jun;15(6):1651-60
pubmed: 18351300
Ann Surg. 2018 Dec;268(6):1058-1068
pubmed: 28692477
Ann Surg. 2017 Mar;265(3):565-573
pubmed: 27918310
Ann Surg. 2009 Jul;250(1):76-80
pubmed: 19561479
Nat Rev Cancer. 2011 Sep 23;11(10):695-707
pubmed: 21941281
Neuroendocrinology. 2016;103(2):153-71
pubmed: 26742109
Am J Clin Oncol. 2012 Dec;35(6):549-56
pubmed: 21659833
Ann Surg. 2014 Sep;260(3):494-501; discussion 501-3
pubmed: 25115425
J Surg Oncol. 2018 Apr;117(5):868-878
pubmed: 29448303
Chin J Cancer. 2017 Jun 21;36(1):51
pubmed: 28637502
Pancreas. 2010 Aug;39(6):825-8
pubmed: 20431423
J Surg Oncol. 2016 Mar;113(3):283-8
pubmed: 26603829
JAMA Surg. 2015 Aug;150(8):701-10
pubmed: 26062046
Br J Surg. 2006 Oct;93(10):1232-7
pubmed: 16804874
Surgery. 2014 Jun;155(6):977-88
pubmed: 24856119
Pancreas. 2013 May;42(4):557-77
pubmed: 23591432
J Am Coll Surg. 2017 Jun;224(6):1057-1064
pubmed: 27965134
Ann Surg Oncol. 2010 Jun;17(6):1621-7
pubmed: 20162460
Ann Surg. 2011 Aug;254(2):311-9
pubmed: 21606835
Pancreas. 2018 Mar;47(3):321-325
pubmed: 29401168
Surg Clin North Am. 2016 Dec;96(6):1447-1468
pubmed: 27865287