ASO Author Reflections: Elevated Preoperative Specific Growth Rate is Associated with Shortened Survival After Resection
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Elevated Preoperative Specific Growth Rate is Associated with Shortened Survival After Resection for Pancreatic Neuroendocrine Tumors Jordan J. Baechle, BS1, Paula Marincola Smith, MD2, and Kamran Idrees, MD, MSCI, MMHC, FACS2 Meharry Medical College, School of Medicine, Nashville, TN; 2Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 1
PAST Pancreatic neuroendocrine tumors (PNETs) generally are considered indolent with a favorable prognosis. However, an estimated 10% exhibit aggressive behavior with associated poor prognosis.1 Although surgical resection is the mainstay of treatment for PNETs, current treatment guidelines advocate expectant management of small (B 2 cm) nonfunctional tumors with serial surveillance imaging.2–4 Incidental diagnosis is increasingly common,5 and a need remains to identify patients with aggressive PNET variants, particularly among patients with small nonfunctional tumors managed nonoperatively who may benefit from earlier surgical intervention.
variables, although those with high SGR tumors showed a higher T stage (p = 0.01) for the final operative pathology specimen and also a higher preoperative HbA1c % (median, 6.9 vs. 5.7%; p = 0.01). Importantly, the patients with high SGR tumors had a significantly shorter 5-year overall survival (63 vs. 80%; p = 0.01) and disease-specific survival (72 vs. 91%; p = 0.03) than those with low SGR tumors. Among the 106 patients whose tumors remained small (B 2 cm) at the time of index resection, high SGR also predicted a shorter 5-year overall survival (79 vs. 96%; p = 0.01). In the multivariate analysis, after controlling for tumor-node-metastasis (TNM) staging and HbA1c %, high SGR was independently associated with worse overall survival (hazard ratio 2.67; 95% confidence interval 1.1–6.8; p = 0.04).
PRESENT FUTURE In this retrospective study of the multi-institutional U.S. Neuroendocrine Tumor Study Group database, specific growth rate (SGR, % of growth per day) was calculated for patients with PNETs who had undergone multiple preoperative cross-sectional imaging studies longer than 30 days apart (n = 288).6, 7 The patients at the 90th percentile or higher were considered to have ‘‘high SGR’’ tumors, whereas the remaining patients were thought to have ‘‘low SGR’’ tumors. The patients with high and low SGR tumors were largely similar in demographic and pathologic
Ó Society of Surgical Oncology 2020 First Received: 13 April 2020; Published Online: 28 May 2020 K. Idrees, MD, MSCI, MMHC, FACS e-mail: [email protected]; [email protected]
Because the incidence of small nonfunctional PNET diagnoses continues to rise due to more frequent use of cross-sectional imaging in clinical medicine and surgery, it is important to continue investigating which patients are most likely to benefit from expectant management versus early surgical intervention. The study findings suggest that in addition to absolute tumor size,
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