Multi-institutional development and external validation of a nomogram to predict recurrence after curative resection of pancreatic neuroendocrine tumors

Pulvirenti, A. et al. (2021) Multi-institutional development and external validation of a nomogram to predict recurrence after curative resection of pancreatic neuroendocrine tumors. Annals of Surgery, 274(6), pp. 1051-1057. (doi: 10.1097/SLA.0000000000003579) (PMID:31567347) (PMCID:PMC8557638)

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Abstract

Objective: To develop a nomogram estimating the probability of recurrence free at 5 years after resection for localized grade 1 (G1)/ grade 2 (G2) pancreatic neuroendocrine tumors (PanNETs). Background: Among patients undergoing resection of PanNETs, approximately 17% experience recurrence. It is not established which patients are at risk, with no consensus on optimal follow-up. Method: A multi-institutional database of patients with G1/G2 PanNETs treated at 2 institutions was used to develop a nomogram estimating the rate of freedom from recurrence at 5 years after curative resection. A second cohort of patients from 3 additional institutions was used to validate the nomogram. Prognostic factors were assessed by univariate analysis using Cox regression model. The nomogram was internally validated using bootstrap resampling method and on the external cohort. Performance was assessed by concordance index (c-index) and a calibration curve. Results: The nomogram was constructed using a cohort of 632 patients. Overall, 68% of PanNETs were G1, the median follow-up was 51 months, and we observed 74 recurrences. Variables included in the nomogram were the number of positive nodes, tumor diameter, Ki-67, and vascular/perineural invasion. The model bias-corrected c-index from the internal validation was 0.85, which was higher than European Neuroendocrine Tumors Society/American Joint Committee on Cancer 8th staging scheme (c-index 0.76, P = <0.001). On the external cohort of 328 patients, the nomogram c-index was 0.84 (95% confidence interval 0.79–0.88). Conclusion: Our externally validated nomogram predicts the probability of recurrence-free survival at 5 years after PanNETs curative resection, with improved accuracy over current staging systems. Estimating individual recurrence risk will guide the development of personalized surveillance programs after surgery.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Jamieson, Professor Nigel
Authors: Pulvirenti, A., Javed, A. A., Landoni, L., Jamieson, N. B., Chou, J. F., Miotto, M., He, J., Gonen, M., Pea, A., Tang, L. H., Nessi, C., Cingarlini, S., D’Angelica, M. I., Gill, A. J., Kingham, T. P., Scarpa, A., Weiss, M. J., Balachandran, V. P., Samra, J. S., Cameron, J. L., Jarnagin, W. R., Salvia, R., Wolfgang, C. L., Allen, P. J., and Bassi, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
Journal Name:Annals of Surgery
Publisher:Lippincott, Williams & Wilkins
ISSN:0003-4932
ISSN (Online):1528-1140
Published Online:24 September 2019
Copyright Holders:Copyright © 2019 The Authors2019 Wolters Kluwer Health, Inc.
First Published:First published in Annals of Surgery 274(6):1051-1057
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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