Elsevier

Surgery

Volume 156, Issue 6, December 2014, Pages 1504-1511
Surgery

American Association of Endocrine Surgeons
Comparison of tumor markers for predicting outcomes after resection of nonfunctioning pancreatic neuroendocrine tumors

https://doi.org/10.1016/j.surg.2014.08.043Get rights and content

Background

This study compares the predictability of 5 tumor markers for distant metastasis and mortality in pancreatic neuroendocrine tumors (PNETs).

Methods

A total of 128 patients who underwent pancreatectomy for nonfunctioning PNETs between 1998 and 2011 were evaluated. Tumor specimens were stained via immunochemistry for cytoplasmic and nuclear survivin, cytokeratin 19 (CK19), c-KIT, and Ki67. Univariate and multivariate regression analyses and receiver operating characteristics curve were used to evaluate the predictive value of these markers.

Results

A total of 116 tumors (91%) were positive for cytoplasmic survivin, 95 (74%) for nuclear survivin, 85 (66.4%) for CK19, 3 for c-KIT, and 41 (32%) for Ki67 >3%. Twelve (9%) tumors expressed none of the markers. Survivin, CK19, and c-KIT had no substantial effect on distant metastasis or mortality. Age >55 years, grade 3 histology, distant metastasis, and Ki67 >3% were associated with mortality (P < .05). A cut-off of Ki67 >3% was the best predictor (83%) of mortality with an area under the curve of 0.85. Ki67 >3% also predicted occurrence of distant metastases with odds ratio of 9.22 and 95% confidence interval of 1.55–54.55 (P < .015).

Conclusion

Of the 5 markers studied, only Ki67 >3% was greatly associated with distant metastasis and death. Survivin, CK19, and c-KIT had no prognostic value in nonfunctioning PNETs.

Section snippets

Methods

The databases of NorthShore University Health System, Northwestern Feinberg School of Medicine/Jesse Brown VA Medical Center, University of Chicago Medical Center, and Rush University Medical Center were reviewed to identify patients who had pancreatectomy for nonfunctioning PNETs between 1998 and 2011. Institutional research board approval was obtained from each institution. Chart reviews were performed, and data were collected regarding patient demographics, mode of presentation, type of

Clinicopathologic characteristics

A total of 128 patients with an age (±SD) of 55 ± 14 years were included in this series. There were 71 males and 57 females. The median patient follow-up was 33 months. Forty-two patients (33%) had undergone a pancreatectomy, 78 (61%) had a distal pancreatectomy, 2 (1%) had an enucleation, and 6 (5%) had a central pancreatectomy. The tumor size was 3.3 ± 2.0 cm, and 56 patients (44%) had a tumor less than or equal to 2 cm. The tumor grade was based on mitotic rate and histologic appearance: 73

Discussion

Finding a cost-effective, reliable preoperative marker of malignant behavior in patients with non-functioning PNETs would be very important to optimize their care. An ideal marker would be one that can be obtained preoperatively and be tested with relative ease without subjectivity. This marker, when detected, should predict the risk of distant metastasis and death with high specificity. The marker would need to be easily obtained (serum or tissue based), reliable, cost-effective, and better

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Cited by (0)

a

Department of Surgery, NorthShore University HealthSystems, Evanston, IL

b

Northwestern University Feinberg School of Medicine/Jesse Brown Medical Center, Chicago, IL

c

University of Chicago, Chicago, IL

d

Rush University Medical Center, Chicago, IL

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