In a single-institution analysis reported in the journal Pancreas, Khetan et al found that age at diagnosis, perineural invasion, and elevated preoperative chromogranin levels may be associated with an increased risk of disease progression in patients with advanced grade 1 or 2 small-bowel neuroendocrine tumors who received multimodal surgical therapy.
"Age at diagnosis, perineural invasion, and elevated preoperative chromogranin level may play a prognostic role in [progression-free survival]."— Khetan et al
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Study Details
The analysis included 99 patients with grade 1 (n = 76) or grade 2 tumors and stage III or IV (n = 63) disease diagnosed and surgically treated at a tertiary referral center (Mount Sinai Hospital, New York) between 2005 and 2009.
Multimodal surgical therapy could include resection of primary tumor or mesenteric masses and resection or enucleation of liver metastases and other extra-intestinal disease. Adjuvant therapies could include somatostatin analogs, peptide receptor radiotherapy, hepatic artery embolization, and chemotherapy. Progression-free survival was defined as time from surgery until disease progression detected by surveillance radiologic imaging.
Key Findings
Overall, disease progression occurred in 48 patients (48%) during follow-up. Death occurred in five patients.
Median progression-free survival in the entire population was 5.7 years, with 5- and 10-year rates of 51% and 19%.
Patients with progressive disease were more likely to have stage IV disease (72.9% vs 54.9%), mesenteric invasion (81.3% vs 60.8%, P < .04), and elevated preoperative chromogranin levels (62.5% vs 47.1%, P < .04) than patients with stable disease. They were also more likely to have undergone an open operative approach (89.6% vs 70.6%, P < .02).
Among a subgroup of 84 patients who received somatostatin analogs either preoperatively or postoperatively and underwent surgical resection, median progression-free survival was 6.06 years, with 5- and 10-year rates of 58% and 20%.
On univariate analysis, age at diagnosis (hazard ratio [HR] = 1.04, P = .002), presence of perineural invasion (HR, 2.19, P = .02), and elevated preoperative chromogranin levels (HR = 2.31, P = .04) were associated with significantly increased risk of disease progression.
Multivariate analysis including age at diagnosis (HR = 1.03, 95% confidence interval [CI] = 1.00–1.06), perineural invasion (HR = 1.70, 95% CI = 0.80–3.63), and elevated preoperative chromogranin levels (HR = 2.24, 95% CI = 0.91–5.52) did not show any significant predictors of disease progression.
The investigators concluded, "Age at diagnosis, perineural invasion, and elevated preoperative chromogranin level may play a prognostic role in [progression-free survival]."
Celia M. Divino, MD, of the Department of General Surgery, Mount Sinai Hospital, is the corresponding author for the Pancreas article.
Disclosure: For full disclosures of the study authors, visit journals.lww.com.
