Specific Growth Rate as a Predictor of Survival in Pancreatic Neuroendocrine Tumors: A Multi-institutional Study from th
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ORIGINAL ARTICLE – PANCREATIC TUMORS
Specific Growth Rate as a Predictor of Survival in Pancreatic Neuroendocrine Tumors: A Multi-institutional Study from the United States Neuroendocrine Study Group Jordan J. Baechle, BS1, Paula Marincola Smith, MD1, Marcus Tan, MD1, Carmen C. Solo´rzano, MD1, Alexandra G. Lopez-Aguiar, MD2, Mary Dillhoff, MD3, Eliza W. Beal, MD3, George Poultsides, MD4, Eleftherios Makris, MD4, Flavio G. Rocha, MD5, Angelena Crown, MD5, Clifford Cho, MD6, Megan Beems, MD6, Emily R. Winslow, MD7, Victoria R. Rendell, MD7, Bradley A. Krasnick, MD8, Ryan Fields, MD8, Shishir K. Maithel, MD2, Christina E. Bailey, MD1, and Kamran Idrees, MD1 1
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN; 2Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA; 3The Ohio State University Comprehensive Cancer Center, Columbus, OH; 4 Stanford University Medical Center, Stanford, CA; 5Virginia Mason Medical Center, Seattle, WA; 6Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI; 7School of Medicine and Public Health, University of Wisconsin, Madison, WI; 8Washington University School of Medicine, St Louis, MO
ABSTRACT Background. Pancreatic neuroendocrine tumors (PNETs) are often indolent; however, identifying patients at risk for rapidly progressing variants is critical, particularly for those with small tumors who may be candidates for expectant management. Specific growth rate (SGR) has been predictive of survival in other malignancies but has not been examined in PNETs. Methods. A retrospective cohort study of adult patients who underwent PNET resection from 2000 to 2016 was performed utilizing the multi-institutional United States Neuroendocrine Study Group database. Patients with C 2 preoperative cross-sectional imaging studies at least 30 days apart were included in our analysis (N = 288). Patients were grouped as ‘‘high SGR’’ or ‘‘low SGR.’’
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08497-4) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 20 June 2019 K. Idrees, MD e-mail: [email protected]; [email protected]
Demographic and clinical factors were compared between the groups. Kaplan–Meier and log-rank analysis were used for survival analysis. Cox proportional hazard analysis was used to assess the impact of various clinical factors on overall survival (OS). Results. High SGR was associated with higher T stage at resection, shorter doubling time, and elevated HbA1c (all P B 0.01). Patients with high SGR had significantly decreased 5-year OS (63 vs 80%, P = 0.01) and diseasespecific survival (72 vs 91%, P = 0.03) compared to those with low SGR. In patients with small (B 2 cm) tumors (N = 106), high SGR predicted lower 5-year OS (79 vs 96%, P = 0.01). On multivariate analysis, high SGR was independently associated with wor
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