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- Title
The accelerated clinical course of pancreatic neuroendocrine tumours: A retrospective analysis of clinical, imaging and pathologic prognostic factors.
- Authors
Chang, Nina; Kendal, Wayne S.; Shabana, Wael; Walker, Alfredo; Balaa, Fady K.; Nyiraneza, Christine; Dawkins, Yvonne; Chatterjee, Avijit; Goodwin, Rachel; Asmis, Timothy; Moyana, Terence N.
- Abstract
Background: Pancreatic neuroendocrine tumours (PNETs) generally behave indolently, even with metastases. However, some tumours manifest an accelerated clinical course (ACC) with poor prognosis. It is unclear whether this is due to intrinsic tumour aggressiveness, dedifferentiation, or progressive tumour accumulation leading to complications. Objectives & methods: We performed a retrospective clinico-pathologic review of 74 PNETs using Kaplan-Meier and Cox proportional hazard analyses to gain further insight into their biology. Results:Median overall survival was 117 months. Five-year survivals were 92% for patients with resected PNETs, versus 35% for non-resected cases (p<0.001). Liver metastases developed in 33/74 patients: 18/33 synchronous metastases (SM) and 15/33 metachronous metastases (MM). There was a significant difference in the Ki67 grade between metastatic and non-metastatic tumours (p<0.001). However, considerable overlap of Ki67 grades existed between MM (9/9 well-differentiated) and SM (5/10 welldifferentiated) tumour groups. Most patients with MM (10/15) showed non-progressive disease, whereas the majority with SM (15/18) manifested progressive disease (p=0.01). There was no significant difference in primary tumour size between these two groups, suggesting that tumours in the synchronous group may be more intrinsically aggressive. On Cox analysis, SM and inoperability were significant predictors of survival, whereas MM, Ki67 grade and T/N stage were not. Conclusions: The ACC for PNETs was associated with SM and inoperability. By multivariate analysis, the strongest adverse prognostic factor was SM. The prognostic value of Ki67 grade on univariate analysis was lost by multivariate analysis. Our findings suggest that the presence of SM in PNETs may reflect intrinsic tumour aggressiveness.
- Publication
Canadian Journal of Pathology, 2016, Vol 8, p43
- ISSN
1918-915X
- Publication type
Article