Outcome after pancreatectomy for neuroendocrine neoplams according to the WHO 2017 grading system: A retrospective multicentric analysis of 138 consecutive patients - 20/09/19

Doi : 10.1016/j.clinre.2019.08.010

Regis Souche ^a,^b,⁎ , Antoine Coignac ^a,^b, Marie Dupuy ^c, Martin Bertrand ^d, Isabelle Raingeart ^e, Boris Guiu ^f, Astrid Herrero ^a,^b, Fabrizio Panaro ^a,^b, Stephane Obled ^g, Fabienne Portales ^h, Benjamin Riviere ⁱ, Jeanne Ramos ⁱ, Frederic Borie ^d, Francois Quenet ^j, Pierre-Emmanuel Colombo ^j, Michel Prudhomme ^d, Eric Assenat ^c, Jean-Michel Fabre ^a,^b
Renaten Languedoc-Roussillon Study Group
Réseau de référence clinique pour les tumeurs endocrines malignes sporadiques et héréditaires^a,^b,^c,^d,^e,^f,^g,^h,^i,^j
^a Digestive and Mini-invasive Surgery unit, Department of Digestive Surgery and Transplantation, St Eloi Hospital, centre hospitalier universitaire, 80, avenue Augustin-Fliche, 34295 Montpellier, France
^b Université de Montpellier-Nîmes, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
^c Department of Medical Oncology, université de Montpellier-Nîmes, centre hospitalier universitaire, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
^d Department of Digestive Surgery, University of Montpellier-Nîmes, Carémeau Hospital, place du professeur Debré, 30900 Nîmes, France
^e Department of Endocrinology, université de Montpellier-Nîmes, centre hospitalier universitaire, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
^f Department of Radiology, université de Montpellier-Nîmes, centre hospitalier universitaire, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
^g Department of Gastroenterology, University of Montpellier-Nîmes, Carémeau Hospital, place du professeur Debré, 30900 Nîmes, France
^h Oncology, université de Montpellier-Nîmes, institut du cancer de Montpellier (ICM), parc Euromédecine, 208, rue des Apothicaires, 34298 Montpellier, France
ⁱ Department of Pathology, université de Montpellier-Nîmes, centre hospitalier universitaire, 641, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
^j Digestive & Oncologic Surgery, université de Montpellier-Nîmes, institut du cancer de Montpellier (ICM), parc Euromédecine, 208, rue des Apothicaires, 34298 Montpellier, France

^⁎Corresponding author at: Digestive and Mini-invasive Surgery unit, Department of Digestive Surgery and Transplantation, St Eloi Hospital, centre hospitalier universitaire, 80, avenue Augustin-Fliche, 34295 Montpellier, France.Digestive and Mini-invasive Surgery unit, Department of Digestive Surgery and Transplantation, St Eloi Hospital, centre hospitalier universitaire80, avenue Augustin-FlicheMontpellier34295France

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 20 September 2019
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Highlights

•	The WHO 2017 grading system is a useful tool for patient prognosis after and the tailoring of therapeutic strategy.
•	The WHO 2017 grading system, age and distant metastasis were independent predictors of worse survival.
•	Symptomatic panNET, lymph node metastasis were independently associated with disease recurrence.
•	PanNET G3 has an intermediate prognosis between panNET G2 and PNEC.
•	Progress in diagnosis tools to distinguish panNET G3 vs. PNEC are required.

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Summary

Aim

The aim of this study was to evaluate the new World Health Organization (WHO) 2017 grading system and the others clinicopathological factors in pancreatic neuroendocrine tumor (panNET) operated patients.

Methods

Histological staging was based on the WHO 2017 grading system. Outcome after surgery and predictors of overall survival (OS) and disease free survival (DFS) were evaluated.

Results

A total of 138 patients underwent surgical resection with a severe morbidity and mortality rates of 14.5% and 0.7% respectively. Five years OS differed according to WHO 2017: 95% among 58 patients with NETG1, 82% in 68 patients with NETG2, 35% in 7 patients with NETG3 and 0% in 5 patients with NECG3 (P<0.0001). Independent predictors of worse OS were age>60 y.o (P=0.014), synchronous metastasis (P=0.005) and WHO 2017 with significant differences between NETG1 versus NETG2 (P=0.005), NETG3 (P<0.001) and NECG3 (P<0.001). Independent predictors of worse DFS were symptomatic NET (P=0.038), pN+ status (P=0.027) and WHO 2017 with significant differences between NETG1 versus NETG3 (P=0.014) and NECG3 (P=0.009).

Conclusion

The WHO 2017 grading system is a useful tool for patient prognosis after panNET resection and the tailoring of therapeutic strategy. Surgery could provide good results in NETG3 patients.

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Keywords : Pancreatectomy, Surgery, Neuroendocrine tumor, Postoperative outcome, Pancreas