Nonfunctioning islet cell carcinoma of the pancreas: an evaluation of seven patients who underwent resection followed by long-term survival

TNM stage and grade in predicting the prognosis of operated, non-functioning neuroendocrine carcinoma of the pancreas--a single-institution experience

OBJECTIVE

To evaluate the prognostic significance of TNM and grading categories in curatively resected non-functioning neuroendocrine pancreatic carcinoma (nfnepC).

METHOD

Eighteen nfnepC were retrospectively analyzed for differences in survival.

RESULTS

(1) There was a correlation between pT (P = 0.026), respectively pM categories (P = 0.016) and survival. (2) G categories and length of survival were closely correlated (P = 0.0036). (3) Disease stages I-IV had a significant effect on survival (P = 0.051). (4) The WHO classification in well and poorly differentiated carcinomas proved to be the most conclusive predictive factor (P = 0.0009). (5) Subgroups with significantly different prognoses determined by histological grade were present within disease stage II.

CONCLUSIONS

The retrospective analysis showed a good correlation between survival and pT, pM, tumor stage, G categories, and WHO classification in well and poorly differentiated carcinomas. Including histological differentiation in the staging system or carrying it out separately in well and poorly differentiated carcinomas, could enhance the predictive potential of TNM-based disease stages.

Malignant nonfunctioning endocrine tumors of the pancreas: predictive factors for survival after surgical treatment

BACKGROUND

There are scant studies that have analyzed the prognostic factors for malignant nonfunctioning endocrine tumors of the pancreas. We identified the predictive factors associated with long-term survival after surgical resection for malignant nonfunctioning endocrine tumors.

METHODS

Among the 25 patients seen at our hospital with a diagnosis of malignant nonfunctioning endocrine tumor, a review was performed on 22 of these patients who were surgically treated at our institution over the last 10 years. The following factors were evaluated for disease-specific mortality: age, gender, tumor location, tumor size, histological differentiation, status of the resection margin, and status of lymph node involvement.

RESULTS

Tumor recurrence was noted in 9 cases (40.9%) among the 22 operated patients. Of the 9 recurrent cases, 7 patients (77.8%) had liver metastases. The median follow-up period was 24.8 (range: 3.7-121.4) months. The overall actuarial 1-, 2- and 5-year survival rates were 84.1%, 72.5%, and 52.8%, respectively. The factor shown to have a favorable independent prognostic significance was a negative resection margin (odds ratio = 19.44, 95% confidence interval = 1.22-310.54, P = 0.036).

CONCLUSIONS

Definitive surgical resection of the primary tumor was a predictor of long-term survival after surgical resection for malignant nonfunctioning endocrine tumor.

Well or poorly differentiated nonfunctioning neuroendocrine carcinoma of the pancreas: a single institution experience with 17 cases

AIM

To evaluate the influence of distinguishing between well and poorly differentiated nonfunctioning neuroendocrine pancreatic carcinomas (PC).

METHOD

Six well differentiated and 11 poorly differentiated nonfunctioning neuroendocrine PC were retrospectively analyzed for differences and compared with 340 ductal PC.

RESULTS

1. There was no difference in pT categories between well differentiated and, poorly differentiated nonfunctioning neuroendocrine PC and ductal PC. 2. The rate of the pN1 category was lower in well differentiated lesions (20%) than in poorly differentiated lesions (66%) and in the ductal PC group (75%). 3. The outcome of patients with R0 resections was significantly better for well differentiated neuroendocrine PC with all patients alive than for poorly differentiated ones and for ductal PC (5-year survival rate 0% and 18%, respectively). 4. The outcome following R1/R2 resections for poorly differentiated neuroendocrine PC tended to be similar than for ductal PC (1-year survival rate 20% vs. 33%). 5. There was no difference in mean survival time (9 months) between poorly differentiated lesions and ductal PC after palliative procedures.

CONCLUSIONS

The better outcome of surgical treatment of nonfunctioning neuroendocrine PC vs. that of ductal PC was confined to well differentiated neuroendocrine lesions. For poorly differentiated lesions the outcome was as poor as for ductal PC. These results underscore the importance to distinguish between well and poorly differentiated nonfunctioning neuroendocrine PC.

Digest

Professor Seiki Matsuno, Chief Editor of Surgery Today (The Japanese Journal of Surgery), has selected from the January to March 1999 issues of the journal for this quarter's digest. A digest of BJS for the same period written by Mr Colin Johnson, Development Officer, appears in the Japanese journal.