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Annals of Surgical Oncology

, Volume 25, Issue 3, pp 647–654 | Cite as

Intrinsic Contact Between T and N Classifications in Resected Well–Moderately Differentiated Locoregional Pancreatic Neuroendocrine Neoplasms

  • Jin-Zhi Xu
  • Wen-Quan Wang
  • Shi-Rong Zhang
  • Hua-Xiang Xu
  • Chun-Tao Wu
  • Zi-Hao Qi
  • He-Li Gao
  • Quan-Xing Ni
  • Liang Liu
  • Xian-Jun Yu
Pancreatic Tumors

Abstract

Background

The role of N classification is controversial in several prognostication systems proposed for pancreatic neuroendocrine neoplasms (pNENs). The widely accepted modified European Neuroendocrine Tumor Society (mENETS) system suggests this contradiction may be related to T classification.

Methods

Data were collected retrospectively from 981 patients in the Surveillance, Epidemiology, and End Results (SEER) database (1973–2012; cohort 1) and 140 patients from the Pancreatic Cancer Institute of Fudan University (2006–2016; cohort 2). All patients had resected well- to moderately differentiated locoregional pNENs, whereby the mENETS system was adopted. Factors related to N1 classification and the association between N and T classifications were analyzed, and N classification prognosis based on T classification was assessed.

Results

In cohorts 1 and 2, tumor size (2–4 cm: p < 0.001 and p = 0.037, respectively; > 4 cm: p < 0.001 and p = 0.012, respectively) and tumors extending beyond the pancreas (p < 0.001 and p = 0.016, respectively), which are factors for T classification, affected N1 classification. For tumors limited to the pancreas, the N1 classification was associated with tumor size (p < 0.001 and p = 0.046, respectively) and predicted poor disease-specific survival (DSS), while for tumors extending beyond the pancreas, the N1 classification did not affect patient outcomes. Findings obtained with data from the SEER database were reproducible with our institutional data.

Conclusions

N classification is associated with T classification, limiting the value of N1 classification for the pNENs tumor-node-metastasis system. A new risk model is necessary to predict patient outcomes and guide clinical practice for the prognosis of pNENs.

Notes

Disclosures

Jin-Zhi Xu, Wen-Quan Wang, Shi-Rong Zhang, Hua-Xiang Xu, Chun-Tao Wu, Zi-Hao Qi, He-Li Gao, Quan-Xing Ni, Liang Liu, and Xian-Jun Yu declare no conflicts of interest.

Funding

This research was supported by the National Natural Science Foundation of China (81402397, 81472670, 81402398, and 81172005), the National Natural Science Foundation of Shanghai (14ZR1407600), and the “Yang-Fan” Plan for Young Scientists of Shanghai (14YF1401100).

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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Jin-Zhi Xu
    • 1
    • 2
    • 3
    • 4
  • Wen-Quan Wang
    • 1
    • 2
    • 3
    • 4
  • Shi-Rong Zhang
    • 1
    • 2
    • 3
    • 4
  • Hua-Xiang Xu
    • 1
    • 2
    • 3
    • 4
  • Chun-Tao Wu
    • 1
    • 2
    • 3
    • 4
  • Zi-Hao Qi
    • 1
    • 2
    • 3
    • 4
  • He-Li Gao
    • 1
    • 2
    • 3
    • 4
  • Quan-Xing Ni
    • 1
    • 2
    • 3
    • 4
  • Liang Liu
    • 1
    • 2
    • 3
    • 4
  • Xian-Jun Yu
    • 1
    • 2
    • 3
    • 4
  1. 1.Shanghai Pancreatic Cancer InstituteShanghaiChina
  2. 2.Pancreatic Cancer InstituteFudan UniversityShanghaiChina
  3. 3.Department of Pancreatic SurgeryFudan University Shanghai Cancer CenterShanghaiChina
  4. 4.Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina

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