Management of MEN1 Related Nonfunctioning Pancreatic NETs: A Shifting Paradigm: Results From the DutchMEN1 Study Group.
Ann Surg
; 267(6): 1155-1160, 2018 06.
Article
en En
| MEDLINE
| ID: mdl-28257328
ABSTRACT
OBJECTIVE:
To assess if surgery for Multiple Endocrine Neoplasia type 1 (MEN1) related nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs) is effective for improving overall survival and preventing liver metastasis.BACKGROUND:
MEN1 leads to multiple early-onset NF-pNETs. The evidence base for guiding the difficult decision who and when to operate is meager.METHODS:
MEN1 patients diagnosed with NF-pNETs between 1990 and 2014 were selected from the DutchMEN1 Study Group database, including >â90% of the Dutch MEN1 population. The effect of surgery was estimated using time-dependent Cox analysis with propensity score restriction and adjustment.RESULTS:
Of the 152 patients, 53 underwent surgery and 99 were managed by watchful waiting. In the surgery group, tumors were larger and faster-growing, patients were younger, more often male, and were more often treated in centers that operated more frequently. Surgery for NF-pNETs was not associated with a significantly lower risk of liver metastases or death, [adjusted hazard ratio (HR) = 0.73 (0.25-2.11)]. Adjusted HR's after stratification by tumor size were NF-pNETs <2âcm = 2.04 (0.31-13.59) and NF-pNETs 2-3âcm = 1.38 (0.09-20.31). Five out of the 6 patients with NF-pNETs >3âcm managed by watchful waiting developed liver metastases or died compared with 6 out of the 16 patients who underwent surgery.CONCLUSIONS:
MEN1 patients with NF-pNETs <2âcm can be managed by watchful waiting, hereby avoiding major surgery without loss of oncological safety. The beneficial effect of a surgery in NF-pNETs 2 to 3âcm requires further research. In patients with NF-pNETs >3âcm, watchful waiting seems not advisable.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Neoplasias Pancreáticas
/
Neoplasia Endocrina Múltiple Tipo 1
Tipo de estudio:
Prognostic_studies
Límite:
Adult
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Ann Surg
Año:
2018
Tipo del documento:
Article
País de afiliación:
Países Bajos