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Lymph Node Sampling Rates and Predictors of Nodal Metastasis in Pancreatic Neuroendocrine Tumor Resections: The UCSF Experience With 149 Patients.
MedLine Citation:
PMID:  22781907     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVES: The decision to perform pancreas-preserving procedures or standard resections for pancreatic neuroendocrine tumors (PNETs) is often based on the perceived risk of malignancy, including potential nodal involvement. We sought to identify clinicopathological factors that predict nodal disease.
METHODS: This is a retrospective review of pathology database for PNET resections from January 1, 1988, to March 15, 2010. Univariate analysis and multivariate logistic regression were used to identify predictors of nodal metastasis.
RESULTS: A total of 149 patients were identified. Enucleations had lower lymph node sampling rates compared to major resections. Excluding enucleations, 23% of patients had no lymph nodes sampled. For patients who did have lymph nodes evaluated, a median of 5 lymph nodes were examined. On multivariate analysis, only distant disease predicted nodal metastasis (odds ratio = 3.80, P = 0.02); tumor size did not (P = 0.48). One third of patients with lymph node metastasis had tumors less than 3 cm.
CONCLUSIONS: Lymph nodes are not evaluated in many major pancreatic resections for PNET, and preoperative prediction of nodal metastasis is difficult, even when tumor size is considered. Consequently, many patients may be understaged and undergo potentially inadequate resection. Inconsistent lymph node sampling may explain conflicting conclusions in the literature regarding the prognostic value of lymph node involvement in PNET patients.
Authors:
Justin R Parekh; Sam C Wang; Emily K Bergsland; Alan P Venook; Robert S Warren; Grace E Kim; Eric K Nakakura
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pancreas     Volume:  41     ISSN:  1536-4828     ISO Abbreviation:  Pancreas     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8608542     Medline TA:  Pancreas     Country:  United States    
Other Details:
Languages:  eng     Pagination:  840-4     Citation Subset:  IM    
Affiliation:
From the *Division of Surgical Oncology, Department of Surgery, †UCSF Helen Diller Family Comprehensive Cancer Center, and ‡Division of Hematology/Oncology, Departments of Medicine and §Pathology, University of California, San Francisco, San Francisco, CA.
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