Annals of Oncology Advance Access published online on January 21, 2008
Annals of Oncology, doi:10.1093/annonc/mdm552
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Prognostic factors at diagnosis and value of WHO classification in a mono-institutional series of 180 non-functioning pancreatic endocrine tumours
1 Department of Surgical and Gastroenterological Sciences
2 Department of Medicine and Public Health
3 Department of Pathology, University of Verona, Verona
4 Department of Digestive and Liver Disease, II School of Medicine, University ‘La Sapienza’, Rome, Italy
* Correspondence to: Dr M. Falconi, Chirurgia Generale B, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Policlinico ‘GB Rossi’, P.le LA Scuro 10, 37134 Verona, Italy. Tel: +39-045-8124553; Fax: +39-045-8201294; E-mail: massimo.falconi{at}univr.it
Background: Non-functioning pancreatic endocrine tumours (NF-PETs) are an aggressive gastroenteropancreatic neoplasm. The present study assessed survival, value of World Health Organisation (WHO) classification and prognostic utility of clinicopathological parameters at diagnosis.
Patients and methods: From 1990 to 2004, 180 patients with NF-PETs were entered in a prospective database, and predictors of prognosis were tested in uni- and multivariate models.
Results: There were 25 (14%) benign lesions, 38 (21%) neoplasms of uncertain behaviour, 100 well-differentiated carcinomas (56%) and 17 poorly differentiated carcinomas (9%). Radical resection was possible in 93 cases (51.6%). Overall 5-, 10- and 15-year survival rates were 67%, 49.3% and 32.8%, respectively, and were significantly higher in radically resected patients (93%, 80.8% and 65.2%, respectively; P < 0.00001). By multivariate analysis, poor differentiation [hazard ratio (HR) 7.3; P = 0.0001], nodal metastases (HR 3.05; P = 0.02), liver metastases (HR 3.29; P = 0.003), Ki-67 >5% (HR 2.5; P = 0.012) and weight loss (HR 3.06; P = 0.001) were significantly associated with mortality.
Conclusion: This study confirms the good long-term survival of patients with NF-PETs and the prognostic value of WHO classification, liver metastases, poor differentiation, Ki-67, nodal metastases and weight loss. These latter two parameters have a prognostic value similar to that of liver metastases and Ki-67.
pancreatic endocrine tumours, pancreatic neoplasm, pancreatic surgery, prognostic factors, survival
Received for publication August 27, 2007. Revision received November 2, 2007. Accepted for publication November 5, 2007.