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• W2889722091 abstract "Background: Management of <2 cm pancreatic neuroendocrine tumors (PanNETs) is controversial. Although often indolent, the oncologic heterogeneity of these tumors, particularly related to lymph node (LN) metastases, poses challenges when deciding between resection vs surveillance. Methods: All pts who underwent curative-intent resection of primary non-functional <2 cm PanNETs at 8 institutions of the US Neuroendocrine Tumor Study Group from 2000 to 2016 were analyzed. Tumors with poor-differentiation and Ki-67 > 20% were excluded. Primary aim was to create a Lymph Node Risk Score (LNRS) that accurately predicted LN metastases for <2 cm PanNETS utilizing readily available preoperative data. Results: Of 695 pts with resected PanNETs, 309 were <2 cm. 25% of tumors were proximal (head/uncinate), 23% had a Ki-673%, and only 8% were moderately-differentiated. 9% of all <2 cm tumors were LN(+), which was associated with worse 5-yr recurrence-free survival compared to LN(-) disease (80% vs 96%;p = 0.007). Preoperatively known factors associated with LN metastases were proximal location (OR4.0; p = 0.002) and Ki-673% (OR2.7;p = 0.05). Moderate-diff was not associated with LN(+) disease. Location and Ki-67 were assigned a value weighted by their odds ratio: (distal: 1, proximal: 4; Ki-67 < 3%: 1, Ki-673%: 3), which formed a LNRS ranging from 1 to 7. Scores were categorized into low(1–2), intermediate(3–4), and high(5–7) risk groups. Incidence of LN metastases progressively increased based on risk group: Low: 3.2%; Intermediate: 13.8%; High: 20.5%(Table). Only 3.4% of Ki-67 < 3% tumors in the distal pancreas were LN(+) compared to 21.4% of Ki-673% tumors in the head/uncinate. Conclusion: This simple and novel LN risk score utilizes readily available preoperative factors (tumor location and Ki-67) to accurately stratify risk of LN metastases for <2 cm PanNETs and may help guide management strategy.Tabled 1Lymph Node Positive Rates for <2cm PanNETsPercentp-valueOR (95%CI)p-valueLymph Node Risk Score<0.001Low (Score 1–2) (n=195)3.2%Ref–Intermediate (Score 3–4) (n=61)13.8%4.9 (1.5–15.7)0.007High (Score 5–7) (n=53)20.5%7.9 (2.5–24.9)<0.001 Open table in a new tab" @default.
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• W2889722091 date "2018-03-01" @default.
• W2889722091 modified "2023-10-02" @default.
• W2889722091 title "The conundrum of <2 cm pancreatic neuroendocrine tumors: a preoperative risk score to predict lymph node metastases and guide surgical management" @default.
• W2889722091 doi "https://doi.org/10.1016/j.hpb.2018.02.014" @default.
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