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

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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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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Author notes

  1. Jin-Zhi Xu, Wen-Quan Wang, and Shi-Rong Zhang contributed equally to this work.

Authors and Affiliations

  1. Shanghai Pancreatic Cancer Institute, Shanghai, China

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

  2. Pancreatic Cancer Institute, Fudan University, Shanghai, China

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

  3. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

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

  4. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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

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  1. Jin-Zhi Xu MD
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  2. Wen-Quan Wang MD, PhD
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Correspondence to Liang Liu MD, PhD or Xian-Jun Yu MD, PhD.

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Xu, JZ., Wang, WQ., Zhang, SR. et al. Intrinsic Contact Between T and N Classifications in Resected Well–Moderately Differentiated Locoregional Pancreatic Neuroendocrine Neoplasms. Ann Surg Oncol 25, 647–654 (2018). https://doi.org/10.1245/s10434-017-6289-1

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  • DOI: https://doi.org/10.1245/s10434-017-6289-1

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