Size alone is not enough: Ki-67 and invasion patterns identify high-risk pancreatic neuroendocrine tumors (pNETs)

Dante Altenfelder Silva Mesquita  Cortelli; Silvio Melo Torres; Igor Correia de Farias; Alessandro Landskron Diniz; Heber Salvador de Castro Ribeiro; André Luis de Godoy; Caroline Almeida Gonçalves; Felipe José Fernández Coimbra

doi:10.1590/0102-672020260000027e1956

article.authors6a34a8e79a4a4

Dante Altenfelder Silva Mesquita Cortelli AC Camargo Hospital https://orcid.org/0000-0002-8448-8634
- Conceptualization
- Investigation
- Methodology
- Formal Analysis
- Writing – Original Draft Preparation
- Writing – Review & Editing
Silvio Melo Torres AC Camargo Hospital https://orcid.org/0000-0001-7274-3602
- Writing – Review & Editing
Igor Correia de Farias AC Camargo Hospital https://orcid.org/0000-0002-4258-8004
- Methodology
- Writing – Original Draft Preparation
Alessandro Landskron Diniz AC Camargo Hospital https://orcid.org/0000-0001-9671-2026
- Writing – Original Draft Preparation
Heber Salvador de Castro Ribeiro AC Camargo Hospital https://orcid.org/0000-0002-3412-7451
- Writing – Original Draft Preparation
André Luis de Godoy AC Camargo Hospital https://orcid.org/0000-0002-7154-1184
- Writing – Review & Editing
Caroline Almeida Gonçalves AC Camargo Hospital https://orcid.org/0000-0003-3363-5275
- Writing – Review & Editing
Felipe José Fernández Coimbra AC Camargo Hospital https://orcid.org/0000-0001-5068-0639
- Conceptualization
- Methodology
- Formal Analysis
- Writing – Original Draft Preparation

DOI:

https://doi.org/10.1590/0102-672020260000027e1956

Keywords:

Neuroendocrine Tumors, Surgical Oncology, Pancreas, Pancreatectomy

Resumen

Background: Pancreatic neuroendocrine tumors (pNETS) constitute a heterogeneous and rare disease worldwide. Diagnosis has been increasing, and the evaluation of prognostic factors has become even more important in the treatment decision process. Aims: To present results and prognostic factors in patients undergoing surgical treatment for pNETS in a single Brazilian center.

Results: The most performed surgical procedure was corpus-caudal pancreatectomy with splenectomy 60.0%. The median hospital stay was 8 (5-13) days, and postoperative mortality occurred in 1.7%. Overall survival in 3 and 5 years was 93.8% and 92.1%. Disease-free survival at 3 and 5 years was 87.1% and 71.8%. Patients with tumors smaller than 2.0 cm did not present with lymph node disease or recurrence and 2.1-2.5cm individuals had lymph node disease in 11.1% and recurrence in 11.1%. In univariate and multivariate analysis, the presence of lymphatic and perineural vascular invasion and Ki67 (3-20) were strongly correlated with positive lymph node disease and recurrence, respectively.

Conclusions: The presence of lymphatic and perineural vascular invasion, Ki67 (3 to 20), and tumors above 2.5 cm correlated with positive lymph node disease and recurrence.