Open AccessSurgery after sunitinib administration to improve survival of patients with advanced pancreatic neuroendocrine neoplasms
Author(s) -
Murase Yoshiki,
Kudo Atsushi,
Akahoshi Keiichi,
Maekawa Aya,
Ishikawa Yoshiya,
Ueda Hiroki,
Ogawa Kosuke,
Ono Hiroaki,
Tanaka Shinji,
Tanabe Minoru
Publication year - 2021
Publication title -
annals of gastroenterological surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.308
H-Index - 15
ISSN - 2475-0328
DOI - 10.1002/ags3.12458
Subject(s) - sunitinib , medicine , lymphadenectomy , hazard ratio , neuroendocrine tumors , surgical oncology , surgery , retrospective cohort study , gastroenterology , cancer , confidence interval
Background Little research is available regarding the treatments combining surgical resection with systemic chemotherapy for advanced pancreatic neuroendocrine neoplasm patients. We retrospectively elucidated whether sunitinib administration before surgery in advanced pancreatic neuroendocrine neoplasm (Pan‐NEN) patients increases survival. Methods This study included 106 of 326 Pan‐NEN patients with distant metastases and/or unresectable locally advanced tumors who visited our department to receive sunitinib for more than 1 mo during April 2002 to December 2019. Risk factors for overall survival (OS) and disease‐free survival (DFS) were analyzed. Results The median duration of preoperative sunitinib administration and observation time after sunitinib were 6 and 26.5 mo, respectively. Of 106 patients, 31 (29.2%) underwent surgery following sunitinib administration. Hepatectomy, synchronous hepatopancreatectomy, pancreatectomy, and lymphadenectomy were performed for 13, 12, 5, and 1 patient, respectively. The 5‐y OS rates in the resected and nonresected groups were 88.9% and 14.1%, respectively ( P < .001). In the multivariate analysis, the absence of surgical resection following sunitinib (hazard ratio [HR], 13.1; P = .001), poor differentiation (HR, 5.5; P = .007), and bilateral liver metastases (HR, 3.7; P = .048) were independent risk factors for OS, although large liver tumor volumes were more evident in the nonresected group, as patient characteristics. The median DFS was 16.1 mo in 22 patients who underwent R0/1 resections, and risk factors for postoperative recurrence were Ki‐67 index >7.8% (HR, 7.4; P = .02) and R1 resection (HR, 4.4; P = .04). Conclusion Surgical resection after sunitinib administration improved OS in advanced Pan‐NENs.