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Frontiers of Medicine

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Front. Med.    2016, Vol. 10 Issue (4) : 444-450    https://doi.org/10.1007/s11684-016-0471-x
RESEARCH ARTICLE
Analysis of 100 consecutive cases of resectable pancreatic neuroendocrine neoplasms: clinicopathological characteristics and long-term outcomes
Yugang Cheng,Hanxiang Zhan,Lei Wang,Jianwei Xu,Guangyong Zhang,Zongli Zhang(),Sanyuan Hu()
Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
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Abstract

The incidence rate of pancreatic neuroendocrine neoplasms (pNENs) has increased rapidly in recent years. However, the clinicopathological characteristics of pNENs are poorly understood. Medical records of patients who underwent surgery and were confirmed as pNENs by pathological examination from January 2003 to February 2015 in Qilu Hospital were reviewed retrospectively. A total of 100 patients, 36 males and 64 females, were included with a mean operation age of 46.26±13.41 years. Among the 100 cases, 76 had insulinomas and 24 had non-functional pNENs. Tumor size ranged from 0.5 cm to 9 cm, and the mean size was 2.20±1.40 cm. The percentages of TNM stages I, II, III, and IV tumors were 89.0%, 8.0%, 0.0%, and 3.0%, respectively. Based on the WHO classification, pNENs were classified into three grades: G1, G2, and G3. G1, G2, and G3 tumors were confirmed in 72.9%, 23.7%, and 3.4% patients, respectively. The positive rates of CgA and Syn immunohistochemical staining were 94.5% (69/73) and 100% (74/74), respectively. Compared with insulinoma, non-functional pNENs have larger tumor sizes, more advanced TNM staging, a higher Ki-67 index, and a higher rate of liver metastasis (P<0.05). In conclusion, pNENs are heterogeneous tumors with varying clinical manifestations, diverse tumor biological characteristics, and different prognoses. Non-functional pNENs present a more aggressive behavioral model and have poorer prognosis than functional pNENs.
Keywords pancreatic neuroendocrine neoplasms      clinicopathological characteristic      Ki-67      liver metastasis      outcomes     
Corresponding Author(s): Zongli Zhang,Sanyuan Hu   
Just Accepted Date: 01 September 2016   Online First Date: 17 October 2016    Issue Date: 01 December 2016
 Cite this article:   
Yugang Cheng,Hanxiang Zhan,Lei Wang, et al. Analysis of 100 consecutive cases of resectable pancreatic neuroendocrine neoplasms: clinicopathological characteristics and long-term outcomes[J]. Front. Med., 2016, 10(4): 444-450.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-016-0471-x
https://academic.hep.com.cn/fmd/EN/Y2016/V10/I4/444
Fig.1  Numbers of pNEN patients who underwent surgery in Qilu Hospital from 2003 to 2015. Cases from 2015 were gathered from January to February.
Fig.2  Age distribution of pNEN patients who underwent surgery.
Total, n (%) Males, n (%) Females, n (%)
Functional
Non-functional
Total		 76 (100.0)
24 (100.0)
100 (100.0)		 26 (34.2)
10 (41.7)
36 (36.0)		 50 (65.8)
14 (58.3)
64 (64.0)
Tab.1  Sex distribution of functional and non-functional pNENs
Imaging methods Total, n Positive, n Sensitivity
B ultrasound 21 13 61.9%
CT 71 65 91.5%
MRI 55 54 98.2%
EUS 21 21 100%
Tab.2  Sensitivity of the most commonly used imaging methods for preoperative localization
Tumor size Total, n (%) Functional, n (%) Non-functional, n (%) P
Tumor size≤1 cm 13 (13) 12 (15.8) 1 (4.2) <0.001
1 cm<tumor size≤2 cm 53 (53) 47 (61.8) 4 (16.7)
2 cm<tumor size≤5 cm 32 (32) 17 (22.4) 15 (62.5)
Tumor size>5 cm 4 (4) 0 4 (16.7)
Tab.3  Distribution of tumor size of functional and non-functional pNENs
Location Total, n (%) Functional, n (%) Non-functional, n (%) P
Single tumor 0.885
Head and uncinate process 34 (34) 28 (36.8) 6 (25.0)
Neck of pancreas 12 (12) 6 (7.9) 6 (25.0)
Distal pancreas 49 (49) 38 (50.0) 11 (45.8)
Multiple tumors
Distal pancreas 3 (3) 3 (3.9) 0
Multiple parts 2 (2) 1 (1.3) 1 (4.2)
Tab.4  Location of primary tumors
Total Functional Non-functional P
WHO grade, n (%) 0.021
G1 43 (72.9) 30 (76.9) 13 (65.0)
G2 14 (23.7) 9 (23.1) 5 (25.0)
G3 2 (3.4) 0 (0) 2 (10.0)
AJCC TNM stage, n (%) <0.001
I 89 (89.0) 76 (93.7) 13 (54.2)
II 8 (8.0) 0 (0) 8 (33.3)
III
IV		 0 (0)
3 (3.0)		 0 (0)
0 (0)		 0 (0)
3 (12.5)
ENETS TNM stage, n (%)
I
II
III
IV		 58 (58.0)
39 (39.0)
0 (0)
3 (3.0)		 55 (72.4)
21 (37.6)
0 (0)
0 (0)		 3 (12.5)
18 (75.0)
0 (0)
3 (12.5)		 <0.001
Ki-67 index, mean±SD, % 2.8±3.6 2.0±1.6 4.2±2.3 0.043
Liver metastases detected during pre-surgery and surgery, n 3 0 3 0.002
Tab.5  Clinicopathological characteristics of 100 pNEN patients
IHC stain Total, n Positive, n Sensitivity
CgA 53 51 96.2%
Syn 53 53 100%
Tab.6  IHC stain of surgical resected specimens
Fig.3  Immunohistochemical staining of CgA and Syn in pNEN tissue.
Surgical procedures Functional, n Non-functional, n Total, n (%)
Pancreatic tumor enucleation 59 8 67 (67)
Distal pancreatectomy and spleen-preserved 14 5 19 (19)
Distal pancreatectomy plus spleen resection 2 3 5 (5)
Central pancreatectomy plus distal pancreas-jejunum anastomosis 0 6 6 (6)
Pancreatoduodenectomy 1 2 3 (3)
Tab.7  Surgical procedures of pNEN patients
Fig.4  Survival curves of pNEN patients.
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