Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Clinicopathologic Characteristics and Prognostic Factors of Nonfunctioning Endocrine Tumor of the Pancreas

췌장의 비기능성 내분비 종양의 임상병리학적 특성 및 예후인자

  • Park, Soo Min (Department of Surgery, Seoul National University College of Medicine) ;
  • Jang, Jin-Young (Department of Surgery, Seoul National University College of Medicine) ;
  • Kang, Mee Joo (Department of Surgery, Seoul National University College of Medicine) ;
  • Yoon, Yoo-Seok (Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Han, Ho-Seong (Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Cho, Jai Young (Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Lee, Seung Eun (Department of Surgery, Chung-Ang University College of Medicine) ;
  • Lee, Kyoung Bun (Department of Pathology, Seoul National University College of Medicine) ;
  • Han, In Woong (Department of Surgery, Seoul National University College of Medicine) ;
  • Kim, Sun-Whe (Department of Surgery, Seoul National University College of Medicine)
  • 박수민 (서울대학교 의과대학 외과학교실) ;
  • 장진영 (서울대학교 의과대학 외과학교실) ;
  • 강미주 (서울대학교 의과대학 외과학교실) ;
  • 윤유석 (서울대학교 의과대학 분당서울대학교병원 외과학교실) ;
  • 한호성 (서울대학교 의과대학 분당서울대학교병원 외과학교실) ;
  • 조재영 (서울대학교 의과대학 분당서울대학교병원 외과학교실) ;
  • 이승은 (중앙대학교 의과대학 외과학교실) ;
  • 이경분 (서울대학교 의과대학 병리학교실) ;
  • 한인웅 (서울대학교 의과대학 외과학교실) ;
  • 김선회 (서울대학교 의과대학 외과학교실)
  • Published : 2011.02.28
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Abstract

Purpose: Nonfunctioning endocrine tumors of the pancreas have no specific symptoms. Therefore, diagnosis is usually delayed and the malignancy rate at the time of diagnosis is reported to be higher than 50%. However, it is difficult to discriminate malignant from benign nonfunctioning endocrine tumors preoperatively. The purpose of this study was to investigate clinical characteristics of nonfunctioning endocrine tumors of the pancreas, including predictive factors of malignancy and prognostic factors affecting long-term survival. Methods: Between 1992 and 2010, clinicopathological data of 53 patients with nonfunctioning endocrine tumors proven by surgical pathology were reviewed retrospectively. Results: Of the 53 patients, mean age was 54 years-old and the male to female ratio was 1 : 1.2 Median follow up was 32.1 months. At the time of diagnosis, liver metastasis was detected in 4 patients. Curative resection was achieved in 49 patients, and 17% of them had recurrence, which was most common in liver. The overall 5-year survival rate was 85.1%. Both the WHO classification (p<0.001) and AJCC staging (p<0.001) correlated well with long-term survival. Univariate analysis revealed preoperative body weight loss (p<0.001), weak enhancement at the early arterial phase (p=0.043), lymph node metastasis (p<0.001), liver metastasis (p=0.001), perineural invasion (p=0.001), or lymphovascular invasion (p=0.010) as prognostic factors. Conclusion: Nonfunctioning endocrine tumor of the pancreas has favorable survival outcomes. Lymph node metastasis (p<0.001), liver metastasis (p=0.001), perineural invasion (p=0.001), and lymphovascular invasion (p=0.010) are poor prognostic factors.

Keywords

References

  1. Buetow PC, Parrino TV, Buck JL, et al. Islet cell tumors of the pancreas: pathologic-imaging correlation among size, necrosis and cysts, calcification, malignant behavior, and functional status. AJR Am J Roentgenol 1995;165:1175-1179. https://doi.org/10.2214/ajr.165.5.7572498
  2. Furukawa H, Mukai K, Kosuge T, et al. Nonfunctioning islet cell tumors of the pancreas: clinical, imaging and pathological aspects in 16 patients. Jpn J Clin Oncol 1998;28:255-261. https://doi.org/10.1093/jjco/28.4.255
  3. Yang CS, Shyr YM, Chiu CT, Su CH, Lin CP, Lin JT. Non-functioning islet cell tumors of the pancreas--a multicentric clinical study in Taiwan. Hepatogastroenterology 2000;47:1747-1749.
  4. Kent RB 3rd, van Heerden JA, Weiland LH. Nonfunctioning islet cell tumors. Ann Surg 1981;193:185-190. https://doi.org/10.1097/00000658-198102000-00010
  5. Broughan TA, Leslie JD, Soto JM, Hermann RE. Pancreatic islet cell tumors. Surgery 1986;99:671-678.
  6. Cheslyn-Curtis S, Sitaram V, Williamson RC. Management of non-functioning neuroendocrine tumors of the pancreas. Br J Surg 1993;80:625-627. https://doi.org/10.1002/bjs.1800800528
  7. Park JS, Lee DH, Jeong S, Cho SG. Determination of diameter and angulation of the normal common bile duct using multidetector computed tomography. Gut Liver 2009;3:306- 310. https://doi.org/10.5009/gnl.2009.3.4.306
  8. Lee SR, Lee JH, Lee SY, et al. The usefulness of endoscopic ultrasonography in the diagnosis of choledocholithiasis without common bile duct dilatation. Korean J Gastroenterol 2010;56:97-102. https://doi.org/10.4166/kjg.2010.56.2.97
  9. Stephen BE, David RB, Carolyn CC. AJCC cancer staging manual. 7th ed. Chicago, USA: Springer; 2009.
  10. Hamilton SR, Aaltonen LA. In: WHO Classification of Tumors. Pathology and Genetics of Tumours of Digestive System. Hamilton SR, Aaltonen LA, editors. Lyon, France: IARC Press; 2000. 204.
  11. Kim BK, Kang CM, Kim JY, et al. Surgical experiences of neuroendocrine neoplasms of the pancreas: comparative study of functioning vs. Non-functioning neoplasms. Korean J Hepatobiliary Pancreat Surg 2007;11:31-36.
  12. Azimuddin K, Chamberlain RS. The surgical management of pancreatic neuroendocrine tumors. Surg Clin North Am 2001;81:511-525. https://doi.org/10.1016/S0039-6109(05)70140-7
  13. Obara T, Shudo R, Fujii T, et al. Pancreatic duct obstruction caused by malignant islet cell tumors of the pancreas. Gastrointest Endosc 2000;51:604-607. https://doi.org/10.1016/S0016-5107(00)70302-6
  14. Solcia E, Capella C, Kloppel G. In: Atlas of Tumor Pathology; 3rd Series, fascicle 20. Washington, DC, USA: AFIP, Armed Forces Institute of Pathology; 1997. 103-114.
  15. Kim HJ, Kim MH, Lee SK, et al. Clinical characteristics and malignant predictive factors in patients with nonfunctioning islet cell tumors of the pancreas. Korean J Gastroenterol 2003;42:57-62.
  16. Chu QD, Hill HC, Douglass HO Jr, et al. Predictive factors associated with long-term survival in patients with neuroendocrine tumors of the pancreas. Ann Surg Oncol 2002; 9:855-862. https://doi.org/10.1007/BF02557521
  17. Sugiyama M, Abe N, Izumisato Y, et al. Differential diagnosis of benign versus malignant nonfunctioning islet cell tumors of the pancreas: the roles of EUS and ERCP. Gastrointest Endosc 2002;55:115-119. https://doi.org/10.1067/mge.2002.119604
  18. Han JH, Kim MH, Moon SH, et al. Clinical characteristics and malignant predictive factors of pancreatic neuroendocrine tumors. Korean J Gastroenterol 2009;53:98-105.
  19. Lee YH, Sohn JH, Yun HJ, et al. Clinical features and long term survival of pancreas neuroendocrine tumors according to the WHO classification. Korean J Hepatobiliary Pancreat Surg 2010;14:199-206.
  20. Evans DB, Skibber JM, Lee JE, et al. Nonfunctioning islet cell carcinoma of the pancreas. Surgery 1993;114:1175-1181.
  21. Paik WH, Yoon YB, Lee SH, et al. Pancreatic endocrine tumors: clinical manifestations and predictive factors associated with survivial. Korean J Gastroenterol 2008;52:171-178.