Therapeutics and Clinical Risk Management (Jul 2022)
Evaluation of Risk Factors for Distant and Lymph Node Metastasis of Pancreatic Neuroendocrine Tumors
Abstract
Bartosz Molasy,1,2 Patryk Zemła,1 Sławomir Mrowiec,3 Ewa Grudzińska,3 Katarzyna Kuśnierz3 1Students’ Scientific Society of the Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland; 2Department of General Surgery, St Alexander Hospital, Kielce, Poland; 3Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, PolandCorrespondence: Ewa Grudzińska, Department of Gastrointestinal Surgery, Medical University of Silesia, Medyków 14, Katowice, 40-752, Poland, Tel +48 32 7894252, Email [email protected]: Metastases of pancreatic neuroendocrine tumors (pNETs) can be found at the time of diagnosis in 20– 50% of cases. Small asymptomatic tumors may be left for observation; however, they can metastasize. The aim of the study was to evaluate risk factors for distant and lymph node metastases of pNETs.Patients and methods: One hundred and fourteen patients with postoperatively confirmed pNET were analyzed retrospectively in a single ENETS Center of Excellence. The relationship between location, size, differentiation of the tumor, and occurrence of lymph node and distant metastases was analyzed.Results: pNETs’ location was pancreatic head – 38 (33.3%), body or tail – 68 (59.7%), and 8 (7.0%) involved the entire organ. Fifty-six (49.1%) tumors were graded G1, 50 (43.9%) G2, and 8 (7.0%) G3. Seventy-two (63.2%) tumors were ≥ 2 cm in diameter, and 42 (36.8%) < 2 cm. Twenty-two (19.3%) patients had distant metastases and 47 (41.2%) had lymph node metastases. In ≥ 2 cm tumors distant and lymph node metastases were more frequent (p < 0.05). Distant metastases incidence was significantly higher in distally located tumors (p = 0.01) and in G2 and G3 tumors (p < 0.01). In 9.5% of < 2cm tumors, distant metastases were present at diagnosis.Conclusion: Distant metastases are more often found in larger, distally located pNETs grade G2 and G3, while a higher occurrence of lymph node metastases seems to be associated only with larger tumor size. A considerable number of tumors < 2 cm in size have distant metastases already at the diagnosis, which might indicate the need for careful qualification of smaller lesions for observation.Keywords: pancreas, neuroendocrine tumor, lymphatic metastasis, lymph nodes, pancreatic surgery
