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• W3199694004 abstract "Presenter: Oriana Ellis MD | William Beaumont Army Medical Center Background: There is conflicting evidence suggesting potential survival advantages associated with surgical intervention for small ( < 2cm) non-functioning pancreatic neuroendocrine tumors (NF-PNET). Over the last decade, however, emerging evidence has developed supporting initial observation with national guidelines now supporting this practice. The purpose of this study was to characterize national trends in the management of localized small NF-PNET and further elucidate factors associated with survival. Methods: The 2004-2015 National Cancer Database was queried for patients with small ( < 2cm, cT1) NF-PNET and clinically negative nodes (cN0). Patients were stratified by observation vs. formal surgical resection (pancreaticoduodenectomy or distal pancreatectomy). Trends and predictors for surgical resection were examined. Patient demographics, disease-, treatment- and outcome-related data were analyzed. Results: Of 2,421 patients meeting inclusion criteria, 1,717 (71%) underwent pancreatectomy with surgery most commonly consisting of distal pancreatectomy (69.9%). Despite a majority of patients undergoing surgery, the rates of pancreatectomy decreased significantly over time, with rates of pancreaticoduodenectomy (slope -2.44, p=0.03) decreasing at a greater magnitude than distal pancreatectomy (slope -1.40, p=0.04). Furthermore, these rates have similarly decreased across all institutional types over time (Figure). Patients selected for surgery tended to be younger (59.4 ± 12.1 vs. 65.4 ± 13.4 years, p2, p=0.01), and have private insurance (54.8% vs. 36.0%, p<0.001) compared to patients undergoing observation. Independent predictors of resection included younger age (OR 0.96; CI 0.95-0.97), private insurance (OR 0.69, CI 0.55-0.87), tumor location within the body or tail (OR 2.0, CI 1.76-2.73), and tumor size 1-2cm (OR 1.81, CI 1.45-2.26). Kaplan-Meier survival analyses demonstrated no difference in survival between observation and surgery for patients with tumors < 1cm (p=0.16), however there was a survival advantage associated with resection among patients with tumors 1-2cm in size (p<0.001). While surgery remained independently prognostic for survival on Cox proportional hazards modeling (HR 2.95, CI 1.87-4.65), tumor size was no longer significant after adjustment for patient-, disease- and treatment-related covariates (p=0.78). Instead, tumor grade represented the single most important prognostic factor for death (HR 5.14, CI 1.83-14.42). Conclusion: Implementation of current evidence-based guidelines for the management of small NF-PNET appears to be occurring over time across institutional types with rates falling more rapidly for pancreaticoduodenectomy compared to distal pancreatectomy. Tumor grade and other socio-demographic factors, rather than tumor size, appear to be the primary determinants of survival seen in this subset of patients." @default.
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• W3199694004 date "2021-01-01" @default.
• W3199694004 modified "2023-10-14" @default.
• W3199694004 title "National trends in the management of small localized non-functioning pancreatic neuroendocrine tumors" @default.
• W3199694004 doi "https://doi.org/10.1016/j.hpb.2021.06.308" @default.
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