A Preoperative Prognostic Score for Resected Pancreatic and Periampullary Neuroendocrine Tumours

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2009-01, Vol.9 (5), p.670-676
• Main Authors: Sakka, Nicole, Smith, Richard A, Whelan, Philip, Ghaneh, Paula, Sutton, Robert, Raraty, Michael, Campbell, Fiona, Neoptolemos, John P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alanine Transaminase - blood; Alkaline Phosphatase - blood; Endocrinology & Metabolism; Female; Gastroenterology and Hepatology; Humans; Kaplan-Meier Estimate; Lymphocyte Count; Male; Middle Aged; Neuroendocrine Tumors - mortality; Neuroendocrine Tumors - surgery; Neuroendocrine tumour, periampullary/pancreatic; Original Paper; Pancreas - surgery; Pancreatectomy - mortality; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - surgery; Platelet Count; Preoperative Period; Prognosis; Prognostic factors, neuroendocrine tumours; Proportional Hazards Models; Prospective Studies; Resection, tumour
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1159/000181179

Abstract Background/Aims: To identify potential preoperative prognostic factors in resected pancreatic and periampullary neuroendocrine tumours. Methods: Clinico-pathological data for 54 consecutive patients with pancreatic or periampullary neuroendocrine tumours referred to our institution over a 10-year period were identified from a prospective database. Results: 34 patients underwent pancreatic resection (12 males, 22 females; median age 54 (IQR 44–71) years). There was a single 30-day mortality (3%). Nodal status (log rank, p = 0.652), microscopic resection margin involvement (p = 0.549) and tumour size (p = 0.122) failed to exhibit any prognostic value. Only the presence of malignant tumour characteristics was associated with poorer overall survival (p = 0.008). Analysis of preoperative parameters showed that age >60 years (p = 0.056), platelet-lymphocyte ratio 1300 (p = 0.008), alkaline phosphatase levels 1125 U/l (p = 0.042) and alanine aminotransferase >35 U/l (p = 0.016) were adverse prognostic factors. A risk stratification score was generated where each adverse preoperative parameter was allocated a score of 1. A cumulative score of ≤1 was defined as low risk, while a score of ≥2 was defined as high risk. Median overall survival in the high-risk group was 10.4 months, while the median survival in the low-risk group was 160 months (p > 0.001). Conclusion: Significant prognostic information can be gained from routine preoperative biochemistry and haematology results in resected pancreatic and periampullary neuroendocrine tumours. These findings merit further evaluation in a larger patient cohort.