Duodenal neuroendocrine tumors: Impact of tumor size and total number of lymph nodes examined.
Ampulla
Duodenum
neuroendocrine tumor
prognosis
surgery
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
18
10
2019
accepted:
27
10
2019
pubmed:
5
11
2019
medline:
4
12
2019
entrez:
5
11
2019
Statut:
ppublish
Résumé
The current study sought to investigate the impact of tumor size and total number of LN examined (TNLE) on the incidence of lymph node metastasis (LNM) among patients with duodenal neuroendocrine tumor (dNET). Patients who underwent curative resection for dNETs between 1997-2016 were identified from 8 high-volume US centers. Risk factors associated with overall survival and LNM were identified and the optimal cut-off of TNLE relative to LNM was determined. Among 162 patients who underwent resection of dNETs, median patient age was 59 (interquartile range [IQR], 51-68) years and median tumor size was 1.2 cm (IQR, 0.7-2.0 cm); a total of 101 (62.3%) patients underwent a concomitant LND at the time of surgery. Utilization of lymphadenectomy (LND) increased relative to tumor size (≤1 cm:52.2% vs 1-2 cm:61.4% vs >2 cm:93.8%; P < .05). Similarly, the incidence of LNM increased with dNET size (≤1 cm: 40.0% vs 1-2 cm:65.7% vs >2 cm:80.0%; P < .05). TNLE ≥ 8 had the highest discriminatory power relative to the incidence of LNM (area under the curve = 0.676). On multivariable analysis, while LNM was not associated with prognosis (hazard ratio [HR] = 0.9; 95% confidence intervals [95%CI], 0.4-2.3), G2/G3 tumor grade was (HR = 1.5; 95%CI, 1.0-2.1). While the incidence of LNM directly correlated with tumor size, patients with dNETs ≤ 1 cm had a 40% incidence of LNM. Regional lymphadenectomy of a least 8 LN was needed to stage patients accurately.
Sections du résumé
BACKGROUND
BACKGROUND
The current study sought to investigate the impact of tumor size and total number of LN examined (TNLE) on the incidence of lymph node metastasis (LNM) among patients with duodenal neuroendocrine tumor (dNET).
METHODS
METHODS
Patients who underwent curative resection for dNETs between 1997-2016 were identified from 8 high-volume US centers. Risk factors associated with overall survival and LNM were identified and the optimal cut-off of TNLE relative to LNM was determined.
RESULTS
RESULTS
Among 162 patients who underwent resection of dNETs, median patient age was 59 (interquartile range [IQR], 51-68) years and median tumor size was 1.2 cm (IQR, 0.7-2.0 cm); a total of 101 (62.3%) patients underwent a concomitant LND at the time of surgery. Utilization of lymphadenectomy (LND) increased relative to tumor size (≤1 cm:52.2% vs 1-2 cm:61.4% vs >2 cm:93.8%; P < .05). Similarly, the incidence of LNM increased with dNET size (≤1 cm: 40.0% vs 1-2 cm:65.7% vs >2 cm:80.0%; P < .05). TNLE ≥ 8 had the highest discriminatory power relative to the incidence of LNM (area under the curve = 0.676). On multivariable analysis, while LNM was not associated with prognosis (hazard ratio [HR] = 0.9; 95% confidence intervals [95%CI], 0.4-2.3), G2/G3 tumor grade was (HR = 1.5; 95%CI, 1.0-2.1).
CONCLUSIONS
CONCLUSIONS
While the incidence of LNM directly correlated with tumor size, patients with dNETs ≤ 1 cm had a 40% incidence of LNM. Regional lymphadenectomy of a least 8 LN was needed to stage patients accurately.
Identifiants
pubmed: 31680243
doi: 10.1002/jso.25753
pmc: PMC10182412
mid: NIHMS1887035
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1302-1310Subventions
Organisme : NCI NIH HHS
ID : K12 CA090625
Pays : United States
Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
JAMA Surg. 2019 Feb 1;154(2):134-140
pubmed: 30383112
J Gastrointest Surg. 2014 Feb;18(2):354-62
pubmed: 24114680
Ann Surg. 2021 Jul 1;274(1):e28-e35
pubmed: 31356277
J Gastrointest Surg. 2018 Sep;22(9):1652-1658
pubmed: 29869091
Ann Oncol. 2012 Jul;23(7):1928
pubmed: 22753260
Am Surg. 2014 Aug;80(8):821-6
pubmed: 25105406
Cancer. 2003 Feb 15;97(4):934-59
pubmed: 12569593
Ann Surg Oncol. 2018 Feb;25(2):528-534
pubmed: 29164413
Surg Oncol. 2003 Aug;12(2):153-72
pubmed: 12946486
Langenbecks Arch Surg. 2018 Aug;403(5):581-589
pubmed: 30043166
Scand J Gastroenterol. 2018 Jun - Jul;53(7):835-842
pubmed: 29726295
J Clin Oncol. 2008 Jun 20;26(18):3063-72
pubmed: 18565894
Langenbecks Arch Surg. 2017 Sep;402(6):925-933
pubmed: 27915372
Arch Pathol Lab Med. 1990 Jul;114(7):700-4
pubmed: 1694655
Neuroendocrinology. 2006;84(3):165-72
pubmed: 17312376
Surgery. 2015 Aug;158(2):466-71
pubmed: 26013986
Ann Surg Oncol. 2018 Oct;25(11):3200-3206
pubmed: 30054824
J Gastrointest Surg. 2017 Aug;21(8):1262-1269
pubmed: 28516311
Best Pract Res Clin Gastroenterol. 2012 Dec;26(6):719-35
pubmed: 23582915
J Gastrointest Surg. 2014 Mar;18(3):457-62; discussion 462-3
pubmed: 24448999
Neuroendocrinology. 2016;103(2):119-24
pubmed: 26784901
J Gastrointest Surg. 2016 Jun;20(6):1098-105
pubmed: 27008594
Gastrointest Endosc. 1999 Mar;49(3 Pt 1):358-64
pubmed: 10049420