Background
Schwannomas are rare tumours that pose a significant management challenge in the abdomen, retroperitoneum and pelvis. No data are available to inform management strategy.
Methods
A ...collaborative international cohort study, across specialist sarcoma units, was conducted to include adults presenting between 2000 and 2017 with histopathologically confirmed schwannomas within the abdomen, retroperitoneum or pelvis.
Results
Of 485 patients across 12 centres, 38 (7·8 per cent) were discharged without follow‐up, 199 (41·0 per cent) underwent early resection and 248 (51·1 per cent) had radiological monitoring. Of these 248 patients, 96 (38·7 per cent) eventually had surgery, giving an overall resection rate of 60·8 per cent (295 of 485). At baseline, median tumour volume was 90·1 (i.q.r. 26·5–262·0) cm3. The estimated growth rate was 10·5 (95 per cent c.i. 9·4 to 11·6) per cent per year, and was consistent in the short term (within 2 years of diagnosis) and long term (beyond 2 years) (ρ = 0·405, P = 0·021). A decision to operate was more common in symptomatic patients (P < 0·001) and for rapidly growing tumours (growth rate more than 20 per cent per year) (P = 0·025). R0/R1 resection was achieved in 91·6 per cent of patients (263 of 287). Kaplan–Meier long‐term recurrence rates after R0/R1 resection were 2·3 and 6·7 per cent at 3 and 5 years respectively.
Conclusion
Specific recommendations include: indications for early surgery, prediction of growth from radiological monitoring, promotion of selective submacroscopic resection and cessation of postoperative imaging surveillance.
Antecedentes
Los schwannomas son tumores raros que plantean un importante desafío para su tratamiento en el abdomen, retroperitoneo y pelvis. No existen datos disponibles que informen de la estrategia de tratamiento.
Métodos
Se llevó a cabo un estudio de cohortes colaborativo internacional, entre unidades especializadas en sarcomas, que incluía a pacientes adultos con schwannomas de la cavidad abdominal, retroperitoneo o pelvis con confirmación histológica que se presentaron entre 2000 y 2017.
Resultados
De 485 pacientes de los 12 centros, 38 (7,8%) fueron dados de alta sin seguimiento, 199 (41,0%) fueron sometidos a resección precoz y 248 (51,1%) pacientes se incluyeron en seguimiento radiológico, de estos últimos 96 pacientes (38,7%) fueron sometidos finalmente a cirugía, con una tasa global de resección del 60,8% (295/485). Al inicio, la mediana del volumen tumoral fue 90,1 cm3 (rango intercuartílico: 26,5‐262,0). La tasa media de crecimiento fue 10,5% por año (i.c. del 95%: 9,4%‐11,6%), siendo uniforme en el seguimiento a corto (durante los 2 años del diagnóstico) y largo plazo (más allá de los 2 años, rho: 0,405, P = 0,021). La decisión de establecer la indicación quirúrgica fue más frecuente en pacientes sintomáticos (P < 0,001) y en tumores con crecimiento rápido (> 20% por año, P = 0,025). Se consiguió una resección R0/R1 en el 91,6%. Las tasas de recidiva a largo plazo de Kaplan‐Meier tras resección R0/R1 fueron 2% y 7% a 3 y 5 años, respectivamente.
Conclusión
Las recomendaciones específicas incluyen: indicaciones para la cirugía precoz, predicción del crecimiento en el seguimiento radiológico, fomentar la resección submacroscópica selectiva, y cese del seguimiento postoperatorio con pruebas de imagen.
Schwannomas present a significant management challenge, and surgery can result in morbidity. Individualized growth rates predicted after a period of radiological monitoring can help guide decision‐making. There is no role for surveillance after resection.
Practical guidelines
Background
Preoperative systemic inflammatory response plays a crucial role in tumorigenesis, progression, and prognosis; and neutrophil, monocyte, and lymphocyte counts serve as important ...biomarkers. An altered monocyte‐to‐lymphocyte ratio (MLR) and neutrophil‐to‐lymphocyte ratio (NLR) has been reported to be associated with a favorable prognosis for certain hematologic malignancies and breast cancer. The aim of this study was to investigate the prognostic significance of MLR, NLR in patients with resectable PNETs.
Methods
Patients undergoing surgery for PNETs between 2000 and 2016 were identified using a large, multi‐center database. NLR and MLR were calculated and Contal and O'Quigley analysis was used to determine the optimal cutoff value.
Results
A total of 620 patients were included in the analytic cohort. The prognostic implications of blood count parameters were evaluated in both univariate and multivariate analysis. The univariate analysis revealed that low MLR and NLR is associated with significantly improved overall survival (OS; P < .01) and recurrence‐free survival (RFS; P < .01). On multivariate analysis, in addition to tumor size and grade, NLR was an independent predictor of improved OS and RFS.
Conclusion
In addition to established tumor‐specific factors, preoperative NLR levels can serve as a valuable biomarker that can be used as a predictor of OS and RFS after resection of PNETs.
Background
To define surgical outcomes of patients with high‐grade gastro‐entero‐pancreatic neuroendocrine neoplasm grade G3 (GEP‐NEN G3).
Methods
Patients who underwent surgical resection between ...2000 and 2016 were identified. The overall survival (OS) and recurrence‐free survival (RFS) of patients with gastro‐entero‐pancreatic neuroendocrine tumors grade G3 (GEP‐NET G3) versus neuroendocrine carcinoma (NEC) were evaluated.
Results
Fifty‐one out of 2182 (2.3%) patients who underwent surgical resection were diagnosed as GEP‐NEN G3. The pancreas was the most common primary site (n = 3772.5%). A majority of patients had lymph node metastasis (n = 3262.7%); one in three (n = 1631.4%) had distant metastasis. The median OS and RFS of the entire cohort were 56.4 and 34.5 months, respectively. Perineural invasion was a strong prognostic factor associate with OS after surgical resection. Patients with NEC had a worse survival outcome versus patients with NET G3 (median OS: 33.1 months vs. not attained, p = 0.088). In contrast, among patients who underwent curative‐intent resection, patients with NEC had comparable RFS versus patients with NET G3 (median RFS: 35.6 vs. 33.9 months, p = 0.774).
Conclusions
Surgical resection provided acceptable short‐ and long‐outcomes for well‐selected patients with resectable GEP‐NEN G3. NEC was associated with a worse OS versus NET G3.
Background and Objectives
Lack of high‐level evidence supporting adjuvant therapy for patients with resected gastroenteropancreatic neuroendocrine tumors (GEP NETs) warrants an evaluation of its ...non‐standard of care use.
Methods
Patients with primary GEP NETs who underwent curative‐intent resection at eight institutions between 2000 and 2016 were identified; 91 patients received adjuvant therapy. Recurrence‐free survival (RFS) and overall survival (OS) were compared between adjuvant cytotoxic chemotherapy and somatostatin analog cohorts.
Results
In resected patients, 33 received cytotoxic chemotherapy, and 58 received somatostatin analogs. Five‐year RFS/OS was 49% and 83%, respectively. Cytotoxic chemotherapy RFS/OS was 36% and 61%, respectively, lower than the no therapy cohort (P < .01). RFS with somatostatin analog therapy (compared to none) was lower (P < .01), as was OS (P = .01). On multivariable analysis, adjuvant cytotoxic therapy was negatively associated with RFS but not OS controlling for patient/tumor‐specific characteristics (RFS P < .01).
Conclusions
Our data, reflecting the largest reported experience to date, demonstrate that adjuvant therapy for resected GEP NETs is negatively associated with RFS and confers no OS benefit. Selection bias enriching our treatment cohort for individuals with unmeasured high‐risk characteristics likely explains some of these results; future studies should focus on patient subsets who may benefit from adjuvant therapy.
Background
To determine short‐ and long‐term oncologic outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) for the treatment of pancreatic ...neuroendocrine tumor (pNET).
Methods
The data of the patients who underwent curative MIDP or ODP for pNET between 2000 and 2016 were collected from a multi‐institutional database. Propensity score matching (PSM) was used to generate 1:1 matched patients with MIDP and ODP.
Results
A total of 576 patients undergoing curative DP for pNET were included. Two hundred and fourteen (37.2%) patients underwent MIDP, whereas 362 (62.8%) underwent ODP. MIDP was increasingly performed over time (2000‐2004: 9.3% vs 2013‐2016: 54.8%; P < 0.01). In the matched cohort (n = 141 in each group), patients who underwent MIDP had less blood loss (median, 100 vs 200 mL, P < 0.001), lower incidence of Clavien‐Dindo ≥ III complications (12.1% vs 24.8%, P = 0.026), and a shorter hospital stay versus ODP (median, 4 versus 7 days, P = 0.026). Patients who underwent MIDP had a lower incidence of recurrence (5‐year cumulative recurrence, 10.1% vs 31.1%, P < 0.001), yet equivalent overall survival (OS) rate (5‐year OS, 92.1% vs 90.9%, P = 0.550) compared with patients who underwent OPD.
Conclusion
Patients undergoing MIDP over ODP in the treatment of pNET had comparable oncologic surgical metrics, as well as similar long‐term OS.
Background
Hepatitis C (HCV) is the primary etiology of hepatocellular carcinoma (HCC) in the US multidisciplinary disease management teams (DMT) that optimize oncologic care. The impact of DMT for ...HCC in safety‐net hospitals is unknown.
Methods
Patients diagnosed with HCC from 2009 to 2016 at Grady Memorial Hospital (GMH) were included. The primary aim was to evaluate referrals to care, receipt of therapy, and overall survival (OS) after DMT formation. Screening patterns of HCV patients for HCC were also examined.
Results
Of 204 HCC patients, median age was 58 years, with 81% male, 83% black. 46% presented with stage 4 disease, 53% had treatment with median OS 9.8 months. DMT formation was associated with increased referrals to surgery (49% vs 30%; P = .02), liver‐directed therapy (58% vs 31%; P = .001), and radiation (13% vs 3%; P = .019). Patients were also more likely to get treatment (59% vs 41%; P = .026), with improved median OS (30.7 vs 4.9 months; P < .001). DMT did not alter HCV screening for HCC (23%). HCV patients screened for HCC had earlier stage disease (P = .001).
Conclusion
Implementation of a DMT at GMH is associated with increased HCC patients referred for/receiving treatment, as well as improved survival. Few patients with HCV at risk for HCC are screened, despite DMT. Future efforts should aim to establish screening programs for HCV patients at risk for HCC.
Background
The risk of recurrence after resection of non‐metastatic gastro‐entero‐pancreatic neuroendocrine tumors (GEP‐NET) is poorly defined. We developed/validated a nomogram to predict risk of ...recurrence after curative‐intent resection.
Methods
A training set to develop the nomogram and test set for validation were identified. The predictive ability of the nomogram was assessed using c‐indices.
Results
Among 1477 patients, 673 (46%) were included in the training set and 804 (54%) in y the test set. On multivariable analysis, Ki‐67, tumor size, nodal status, and invasion of adjacent organs were independent predictors of DFS. The risk of death increased by 8% for each percentage increase in the Ki‐67 index (HR 1.08, 95% CI, 1.05‐1.10; P < 0.001). GEP‐NET invading adjacent organs had a HR of 1.65 (95% CI, 1.03‐2.65; P = 0.038), similar to tumors ≥3 cm (HR 1.67, 95% CI, 1.11‐2.51; P = 0.014). Patients with 1‐3 positive nodes and patients with >3 positive nodes had a HR of 1.81 (95% CI, 1.12‐2.87; P = 0.014) and 2.51 (95% CI, 1.50‐4.24; P < 0.001), respectively. The nomogram demonstrated good ability to predict risk of recurrence (c‐index: training set, 0.739; test set, 0.718).
Conclusion
The nomogram was able to predict the risk of recurrence and can be easily applied in the clinical setting.
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