Hoyos S, Posada-Moreno P, Guzman-Arango N, Chanci-Drago R, Chavez J, Andrés-Duarte A, Salazar-Ochoa S. Pancreatic neuroendocrine tumors: Are tumors smaller than 2 cm truly indolent? World J Gastrointest Oncol 2024; 16(5): 1756-1762 [PMID: 38764809 DOI: 10.4251/wjgo.v16.i5.1756]
Corresponding Author of This Article
Sergio Hoyos, MD, MSc, Adjunct Professor, Chief Doctor, Chief Physician, Hepatobilary and Liver Transplant Unit, Hospital Pablo Tobon Uribe and Gastrohepathology Group Universidad de Antioquia, Calle 70 No. 52-21, Medellin 050034, Antioquia, Colombia. sergiohoyosd@yahoo.es
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. May 15, 2024; 16(5): 1756-1762 Published online May 15, 2024. doi: 10.4251/wjgo.v16.i5.1756
Pancreatic neuroendocrine tumors: Are tumors smaller than 2 cm truly indolent?
Sergio Hoyos, Pablo Posada-Moreno, Natalia Guzman-Arango, Romario Chanci-Drago, Jaime Chavez, Alvaro Andrés-Duarte, Santiago Salazar-Ochoa
Sergio Hoyos, Jaime Chavez, Alvaro Andrés-Duarte, Hepatobilary and Liver Transplant Unit, Hospital Pablo Tobon Uribe and Gastrohepathology Group Universidad de Antioquia, Medellin 050034, Antioquia, Colombia
Pablo Posada-Moreno, Natalia Guzman-Arango, Romario Chanci-Drago, Santiago Salazar-Ochoa, Department of General Surgery, Universidad Pontificia Bolivariana, Medellín 050034, Antioquia, Colombia
Author contributions: Hoyos S and Posada-Moreno P were responsible for the study's design and biostatistical analysis; Guzman-Arango N, Chanci-Drago R, and Salazar-Ochoa S acquired the data; Posada-Moreno P wrote the paper; Hoyos S, Andrés-Duarte A, and Chavez J provided critical review and intellectual input for the manuscript; All authors contributed to the article and approved the final submitted version.
Institutional review board statement: The study was reviewed and approved by the Hospital Pablo Tobón Uribe Institutional Review Board (Approval No. PG-DMD-046-F1).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at sergiohoyosd@yahoo.es.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sergio Hoyos, MD, MSc, Adjunct Professor, Chief Doctor, Chief Physician, Hepatobilary and Liver Transplant Unit, Hospital Pablo Tobon Uribe and Gastrohepathology Group Universidad de Antioquia, Calle 70 No. 52-21, Medellin 050034, Antioquia, Colombia. sergiohoyosd@yahoo.es
Received: December 20, 2023 Peer-review started: December 20, 2023 First decision: January 10, 2024 Revised: February 7, 2024 Accepted: March 25, 2024 Article in press: March 25, 2024 Published online: May 15, 2024 Processing time: 140 Days and 17.2 Hours
Abstract
BACKGROUND
Pancreatic neuroendocrine tumors (PNETs) are relatively rare but rank as the second most common pancreatic neoplasm. They can be functional, causing early metabolic disturbances due to hormone secretion, or non-functional and diagnosed later based on tumor size-related symptoms. Recent diagnoses of PNETs under 2 cm in size have sparked debates about their management; some practitioners advocate for surgical removal and others suggest observation due to the tumors’ lower potential for malignancy. However, it is unclear whether managing these small tumors expectantly is truly safe.
AIM
To evaluate poor prognostic factors in PNETs based on tumor size (> 2 cm or < 2 cm) in surgically treated patients.
METHODS
This cohort study included 64 patients with PNETs who underwent surgical resection between 2006 and 2019 at a high-complexity reference hospital in Medellín, Colombia. To assess patient survival, quarterly follow-ups were conducted during the first year after surgery, followed by semi-annual consultations at the hospital's hepatobiliary surgery department. Qualitative variables were described using absolute and relative frequencies, and quantitative variables were expressed using measures of central tendency and their corresponding measures of dispersion.
RESULTS
The presence of lymph node involvement, neural involvement, and lymphovascular invasion were all associated with an increased risk of mortality, with hazard ratios of 5.68 (95%CI: 1.26–25.61, P = 0.024), 6.44 (95%CI: 1.43–28.93, P = 0.015), and 24.87 (95%CI: 2.98–207.19, P = 0.003), respectively. Neural involvement and lymphovascular invasion were present in tumors smaller than 2 cm in diameter and those larger than 2 cm in diameter. The recurrence rates between the two tumor groups were furthermore similar: 18.2% for tumors smaller than 2 cm and 21.4% for tumors larger than 2 cm. Patient survival was additionally comparable between the two tumor groups.
CONCLUSION
Tumor size does not dictate prognosis; lymph node and lymphovascular involvement affect mortality, which highlights that histopathological factors-rather than tumor size-may play a role in management.
Core Tip: Pancreatic neuroendocrine tumors (PNETs) are relatively uncommon but represent the second most frequent pancreatic neoplasm. This study, conducted in Colombia, challenges conventional size-based survival expectations for PNETs and advocates a surgical approach, even for tumors smaller than 2 cm. The findings underscore the importance of considering histological traits like lymphovascular and neural invasion, high mitotic index, and a Ki67 proliferation index exceeding 3%. These characteristics, traditionally associated with larger tumors and higher mortality rates, were also identified in a significant fraction of smaller tumors. More comprehensive studies are necessary to redefine clinical approaches and guidelines for managing PNETs.
