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  • A Preoperative Clinical Ris...
    Primavesi, Florian; Andreasi, Valentina; Hoogwater, Frederik J H; Partelli, Stefano; Wiese, Dominik; Heidsma, Charlotte; Cardini, Benno; Klieser, Eckhard; Marsoner, Katharina; Fröschl, Uwe; Thalhammer, Sabine; Fischer, Ines; Göbel, Georg; Hauer, Andreas; Kiesslich, Tobias; Ellmerer, Philipp; Klug, Reinhold; Neureiter, Daniel; Wundsam, Helwig; Sellner, Franz; Kornprat, Peter; Függer, Reinhold; Öfner, Dietmar; Nieveen van Dijkum, Elisabeth J M; Bartsch, Detlef K; de Kleine, Ruben H J; Falconi, Massimo; Stättner, Stefan

    Cancers, 05/2020, Letnik: 12, Številka: 5
    Journal Article

    Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) is highly variable depending on various factors. Risk stratification with preoperatively available parameters could guide decision-making in multidisciplinary treatment concepts. C-reactive Protein (CRP) is linked to inferior survival in several malignancies. This study assesses CRP within a novel risk score predicting histology and outcome after surgery for sporadic non-functional panNENs. A retrospective multicenter study with national exploration and international validation. CRP and other factors associated with overall survival (OS) were evaluated by multivariable cox-regression to create a clinical risk score (CRS). Predictive values regarding OS, disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by time-dependent receiver-operating characteristics. Overall, 364 patients were included. Median CRP was significantly higher in patients >60 years, G3, and large tumors. In multivariable analysis, CRP was the strongest preoperative factor for OS in both cohorts. In the combined cohort, CRP (cut-off ≥0.2mg/dL; hazard-ratio (HR):3.87), metastases (HR:2.80), and primary tumor size ≥3.0cm (HR:1.83) showed a significant association with OS. A CRS incorporating these variables was associated with postoperative histological grading, T category, nodal positivity, and 90-day morbidity/mortality. Time-dependent area-under-the-curve at 60 months for OS, DSS, and RFS was 69%, 77%, and 67%, respectively (all < 0.001), and the inclusion of grading further improved the predictive potential (75%, 84%, and 78%, respectively). CRP is a significant marker of unfavorable oncological characteristics in panNENs. The proposed internationally validated CRS predicts histological features and patient survival.