A single institution's 26-year experience with nonfunctional pancreatic neuroendocrine tumors

A validation of current staging systems and a new prognostic nomogram

Trevor A. Ellison, Christopher L. Wolfgang, Chanjuan Shi, John L. Cameron, Peter Murakami, Liew Jun Mun, Aatur D. Singhi, Toby C. Cornish, Kelly Olino, Zina Meriden, Michael Choti, Luis A. Diaz, Timothy M. Pawlik, Richard D. Schulick, Ralph H. Hruban, Barish H. Edil

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

OBJECTIVE:: To validate the 2010 American Joint Committee on Cancer (AJCC) and 2006 European Neuroendocrine Tumor Society (ENETS) tumor staging systems for pancreatic neuroendocrine tumors (PanNETs) using the largest, single-institution series of surgically resected patients in the literature. BACKGROUND:: The natural history and prognosis of PanNETs have been poorly defined because of the rarity and heterogeneity of these neoplasms. Currently, there are 2 main staging systems for PanNETs, which can complicate comparisons of reports in the literature and thereby hinder progress against this disease. METHODS:: Univariate and multivariate analyses were conducted on the prognostic factors of survival using 326 sporadic, nonfunctional, surgically resected PanNET patients who were cared for at our institution between 1984 and 2011. Current and proposed models were tested for survival prognostication validity as measured by discrimination (Harrel's c-index, HCI) and calibration. RESULTS:: Five-year overall-survival rates for AJCC stages I, II, and IV are 93% (88%-99%), 74% (65%-83%), and 56% (42%-73%), respectively, whereas ENETS stages I, II, III, and IV are 97% (92%-100%), 87% (80%-95%), 73% (63%-84%), and 56% (42%-73%), respectively. Each model has an HCI of 0.68, and they are no different in their ability to predict survival. We developed a simple prognostic tool just using grade, as measured by continuous Ki-67 labeling, sex, and binary age that has an HCI of 0.74. CONCLUSIONS:: Both the AJCC and ENETS staging systems are valid and indistinguishable in their survival prognostication. A new, simpler prognostic tool can be used to predict survival and decrease interinstitutional mistakes and uncertainties regarding these neoplasms.

Original languageEnglish (US)
Pages (from-to)204-212
Number of pages9
JournalAnnals of Surgery
Volume259
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

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Nomograms
Neuroendocrine Tumors
Survival
Neoplasm Staging
Neoplasms
Natural History
Calibration
Uncertainty
Multivariate Analysis
Survival Rate

Keywords

  • AJCC
  • ENETS
  • grade
  • nomogram
  • nonfunctional
  • pancreatic neuroendocrine tumors
  • staging systems

ASJC Scopus subject areas

  • Surgery

Cite this

A single institution's 26-year experience with nonfunctional pancreatic neuroendocrine tumors : A validation of current staging systems and a new prognostic nomogram. / Ellison, Trevor A.; Wolfgang, Christopher L.; Shi, Chanjuan; Cameron, John L.; Murakami, Peter; Mun, Liew Jun; Singhi, Aatur D.; Cornish, Toby C.; Olino, Kelly; Meriden, Zina; Choti, Michael; Diaz, Luis A.; Pawlik, Timothy M.; Schulick, Richard D.; Hruban, Ralph H.; Edil, Barish H.

In: Annals of Surgery, Vol. 259, No. 2, 02.2014, p. 204-212.

Research output: Contribution to journalArticle

Ellison, TA, Wolfgang, CL, Shi, C, Cameron, JL, Murakami, P, Mun, LJ, Singhi, AD, Cornish, TC, Olino, K, Meriden, Z, Choti, M, Diaz, LA, Pawlik, TM, Schulick, RD, Hruban, RH & Edil, BH 2014, 'A single institution's 26-year experience with nonfunctional pancreatic neuroendocrine tumors: A validation of current staging systems and a new prognostic nomogram', Annals of Surgery, vol. 259, no. 2, pp. 204-212. https://doi.org/10.1097/SLA.0b013e31828f3174
Ellison, Trevor A. ; Wolfgang, Christopher L. ; Shi, Chanjuan ; Cameron, John L. ; Murakami, Peter ; Mun, Liew Jun ; Singhi, Aatur D. ; Cornish, Toby C. ; Olino, Kelly ; Meriden, Zina ; Choti, Michael ; Diaz, Luis A. ; Pawlik, Timothy M. ; Schulick, Richard D. ; Hruban, Ralph H. ; Edil, Barish H. / A single institution's 26-year experience with nonfunctional pancreatic neuroendocrine tumors : A validation of current staging systems and a new prognostic nomogram. In: Annals of Surgery. 2014 ; Vol. 259, No. 2. pp. 204-212.
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abstract = "OBJECTIVE:: To validate the 2010 American Joint Committee on Cancer (AJCC) and 2006 European Neuroendocrine Tumor Society (ENETS) tumor staging systems for pancreatic neuroendocrine tumors (PanNETs) using the largest, single-institution series of surgically resected patients in the literature. BACKGROUND:: The natural history and prognosis of PanNETs have been poorly defined because of the rarity and heterogeneity of these neoplasms. Currently, there are 2 main staging systems for PanNETs, which can complicate comparisons of reports in the literature and thereby hinder progress against this disease. METHODS:: Univariate and multivariate analyses were conducted on the prognostic factors of survival using 326 sporadic, nonfunctional, surgically resected PanNET patients who were cared for at our institution between 1984 and 2011. Current and proposed models were tested for survival prognostication validity as measured by discrimination (Harrel's c-index, HCI) and calibration. RESULTS:: Five-year overall-survival rates for AJCC stages I, II, and IV are 93{\%} (88{\%}-99{\%}), 74{\%} (65{\%}-83{\%}), and 56{\%} (42{\%}-73{\%}), respectively, whereas ENETS stages I, II, III, and IV are 97{\%} (92{\%}-100{\%}), 87{\%} (80{\%}-95{\%}), 73{\%} (63{\%}-84{\%}), and 56{\%} (42{\%}-73{\%}), respectively. Each model has an HCI of 0.68, and they are no different in their ability to predict survival. We developed a simple prognostic tool just using grade, as measured by continuous Ki-67 labeling, sex, and binary age that has an HCI of 0.74. CONCLUSIONS:: Both the AJCC and ENETS staging systems are valid and indistinguishable in their survival prognostication. A new, simpler prognostic tool can be used to predict survival and decrease interinstitutional mistakes and uncertainties regarding these neoplasms.",
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T2 - A validation of current staging systems and a new prognostic nomogram

AU - Ellison, Trevor A.

AU - Wolfgang, Christopher L.

AU - Shi, Chanjuan

AU - Cameron, John L.

AU - Murakami, Peter

AU - Mun, Liew Jun

AU - Singhi, Aatur D.

AU - Cornish, Toby C.

AU - Olino, Kelly

AU - Meriden, Zina

AU - Choti, Michael

AU - Diaz, Luis A.

AU - Pawlik, Timothy M.

AU - Schulick, Richard D.

AU - Hruban, Ralph H.

AU - Edil, Barish H.

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N2 - OBJECTIVE:: To validate the 2010 American Joint Committee on Cancer (AJCC) and 2006 European Neuroendocrine Tumor Society (ENETS) tumor staging systems for pancreatic neuroendocrine tumors (PanNETs) using the largest, single-institution series of surgically resected patients in the literature. BACKGROUND:: The natural history and prognosis of PanNETs have been poorly defined because of the rarity and heterogeneity of these neoplasms. Currently, there are 2 main staging systems for PanNETs, which can complicate comparisons of reports in the literature and thereby hinder progress against this disease. METHODS:: Univariate and multivariate analyses were conducted on the prognostic factors of survival using 326 sporadic, nonfunctional, surgically resected PanNET patients who were cared for at our institution between 1984 and 2011. Current and proposed models were tested for survival prognostication validity as measured by discrimination (Harrel's c-index, HCI) and calibration. RESULTS:: Five-year overall-survival rates for AJCC stages I, II, and IV are 93% (88%-99%), 74% (65%-83%), and 56% (42%-73%), respectively, whereas ENETS stages I, II, III, and IV are 97% (92%-100%), 87% (80%-95%), 73% (63%-84%), and 56% (42%-73%), respectively. Each model has an HCI of 0.68, and they are no different in their ability to predict survival. We developed a simple prognostic tool just using grade, as measured by continuous Ki-67 labeling, sex, and binary age that has an HCI of 0.74. CONCLUSIONS:: Both the AJCC and ENETS staging systems are valid and indistinguishable in their survival prognostication. A new, simpler prognostic tool can be used to predict survival and decrease interinstitutional mistakes and uncertainties regarding these neoplasms.

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