Detection of pancreatic neuroendocrine tumors: 23 years of experience

Abstract

Introduction and aims: Neuroendocrine tumors are of great scientific interest, given that they are difficult to diagnose and treat. Despite being relatively rare (< 1/100,000 individuals, 1-2% of the gastrointestinal neoplasias) and indolent, their potential malignancy must not be forgotten. An increase in the number of diagnosed tumors has been observed in recent years. The aim of the present study was to update a published case series of 19 patients suspected of presenting with pancreatic neuroendocrine tumor with 51 current cases, to study and compare the new results with those of the previous case series, as well as with other recent publications from Spain, the United States, China, and India. Materials and methods: A retrospective, multicenter case series was conducted on 70 patients (19 cases published in 2011), whose data has been collected over a period of 23 years. The variables analyzed were: age, sex, symptomatology, tumor size, location, metastasis, final diagnosis, and surgery, among others. Results: Mean patient age was 55 years and 60% of the patients were men. Disease location was the pancreatic head in 28.5% of the patients and the tail in 27.1%, mean tumor size was 3.9 cm (0.2-10 cm), 71.4% of the patients had non-functioning tumors, 32.8% had metastases (100% to the liver), 74.2% of the patients were operated on, and actuarial survival was 75%. Conclusions: Differences were observed between the previously published case series and the current results. There was an increase in incidentalomas and non-functioning tumors, but no variation in the overall survival rate. The differences with other case series (age, sex, and tumor location) were dependent on the country where the cases were compiled. The increase in tumors could be related to a higher number of diagnoses made through imaging studies and to the greater sensitivity of the devices employed. Resumen: Introducción y objetivos: Los tumores neuroendocrinos generan un gran interés científico, dada la dificultad de su diagnóstico y tratamiento. A pesar de ser relativamente raros (<1/100,000 individuos, 1-2% de las neoplasias digestivas) e indolentes, no se debe olvidar que, en última instancia, son potencialmente malignos. En los últimos años, se ha observado un incremento en el número de tumores diagnosticados.El objetivo del estudio fue la actualización de una serie publicada de 19 casos con sospecha de tumor neuroendocrino pancreático, con otros 51 casos actuales, para el estudio y comparación de los nuevos resultados tanto con la serie anterior como con otras publicadas recientemente en España, Estados Unidos, China e India. Material y métodos: Serie retrospectiva, multicéntrica de 70 pacientes (19 publicados en 2011) recopilados a lo largo de 23 años. Variables analizadas: edad, sexo, sintomatología, tamaño, localización, metástasis, diagnóstico final y cirugía, entre otras. Resultados: Edad media de 55 años; 60% hombres; localización: cabeza (28.5%) y cola (27.1%); tamaño medio 3,9 cm (0,2-10 cm); no funcionantes el 71.4%; metástasis en el 32.8% (100% hepáticas), operados el 74.2% y supervivencia actuarial del 75%. Conclusiones: Se observan diferencias entre la serie anteriormente publicada y los resultados actuales, con un incremento del porcentaje de incidentalomas y de tumores no funcionantes, pero sin variación en la tasa de supervivencia global. Con otras series actuales, las diferencias (edad, sexo y localización tumoral) dependen del país donde se han recopilado los casos. Este incremento podría relacionarse con el aumento del diagnóstico por la imagen y con la mayor la sensibilidad de los dispositivos. Keywords: Pancreatic neuroendocrine tumors, Endoscopic ultrasound, Endoscopic ultrasound-guided fine needle aspiration, Palabras clave: Tumores neuroendocrinos pancreáticos, Ultrasonografía endoscópica, Punción aspiración con aguja fina guiada por ecoendoscopia