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Duodenal neuroendocrine tumors: Impact of tumor size and total number of lymph nodes examined
Author(s) -
Zhang XuFeng,
Wu XiaoNing,
Tsilimigras Diamantis I.,
Poultsides George,
Rocha Flavio,
Abbott Daniel E.,
Fields Ryan,
Idrees Kamran,
Cho Cliff,
Maithel Shishir K.,
Pawlik Timothy M.
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25753
Subject(s) - medicine , interquartile range , confidence interval , hazard ratio , lymphadenectomy , incidence (geometry) , concomitant , neuroendocrine tumors , lymph node , surgical oncology , metastasis , gastroenterology , surgery , cancer , physics , optics
Background The current study sought to investigate the impact of tumor size and total number of LN examined (TNLE) on the incidence of lymph node metastasis (LNM) among patients with duodenal neuroendocrine tumor (dNET). Methods Patients who underwent curative resection for dNETs between 1997‐2016 were identified from 8 high‐volume US centers. Risk factors associated with overall survival and LNM were identified and the optimal cut‐off of TNLE relative to LNM was determined. Results Among 162 patients who underwent resection of dNETs, median patient age was 59 (interquartile range [IQR], 51‐68) years and median tumor size was 1.2 cm (IQR, 0.7‐2.0 cm); a total of 101 (62.3%) patients underwent a concomitant LND at the time of surgery. Utilization of lymphadenectomy (LND) increased relative to tumor size (≤1 cm:52.2% vs 1‐2 cm:61.4% vs >2 cm:93.8%; P < .05). Similarly, the incidence of LNM increased with dNET size (≤1 cm: 40.0% vs 1‐2 cm:65.7% vs >2 cm:80.0%; P < .05). TNLE ≥ 8 had the highest discriminatory power relative to the incidence of LNM (area under the curve = 0.676). On multivariable analysis, while LNM was not associated with prognosis (hazard ratio [HR] = 0.9; 95% confidence intervals [95%CI], 0.4‐2.3), G2/G3 tumor grade was (HR = 1.5; 95%CI, 1.0‐2.1). Conclusions While the incidence of LNM directly correlated with tumor size, patients with dNETs ≤ 1 cm had a 40% incidence of LNM. Regional lymphadenectomy of a least 8 LN was needed to stage patients accurately.