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Modified tumor staging system improves prognostics for pancreatic neuroendocrine tumors
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A modified version of the European Neuroendocrine Tumor Society’s, or ENETS, staging system was better suited for use on pancreatic neuroendocrine tumors than either the ENETS or American Joint Committee on Cancer classification, study data show.
“Pancreatic neuroendocrine tumor is a rare malignancy with relatively indolent biologic behavior compared with pancreatic adenocarcinoma,” Guopei Luo, of the Fudan University Shanghai Cancer Center, and colleagues wrote. “Its incidence has been increasing sharply in recent years, possibly due to the wide application of modern imaging and endoscopic technologies. Therefore, an accurate and simple staging system that can provide prognostic information and stratify patients by risk is needed.”
Luo and colleagues evaluated both the ENETS and the American Joint Committee on Cancer (AJCC) staging systems, as well as a modified system, which kept the ENETS T, N, and M definitions in place and adopting the staging definitions set by the AJCC system.
Researchers used the SEER database to identify 2,529 patients (median age, 57 years) treated for pancreatic neuroendocrine tumors from 1973 to 2012, and another 1,143 patients (median age, 53.9 years) from a multicentric database using information from eight Chinese and two American institutions. Both groups had a male-to-female patient ratio of approximately 1:1.
Median survival was 139 months.
The AJCC staging system identified stage III disease in a small portion of both the SEER (2.2%) and multicenter patients (2.2%). The ENETS system gave patients with stage I disease a similar prognosis as those with stage IIA disease; patients with stage IIIB disease had a lower HR for death than stage IIIA disease.
The modified system identified stage II disease in 8.9% of the SEER database patients and 11.6% of the multicenter database patients. It also found a higher hazard ratio for death in patients with stage III disease than in those with stage IIB disease.
In an accompanying editorial, Daniel M. Halperin, MD, James C. Yao, MD and Arvind Dasari, MD, all of the The University of Texas MD Anderson Cancer Center, wrote that the modified staging system would not immediately change clinical practice.
“However, by improving our prognostic capabilities, this staging system offers the potential to predict which patients will benefit from anatomic staging to make it maximally informative,” they wrote. “For subgroups of rare tumors like pancreatic neuroendocrine tumors, progress is only possible through remarkable collaborative efforts, such as those underpinning [this study]. Fortunately, these collaborative efforts are a hallmark of the neuroendocrine tumor field, and progress continues to accelerate.” – by Andy Polhamus
Disclosure: Luo reports no relevant financial disclosures. Please see the study for a list of all other researchers’ relevant financial disclosures. Dasari reports consulting and advisory roles with Ipsen, as well as research funding from Ipsen and Novartis.
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