Revised nodal stage for pancreatic neuroendocrine tumors

Guopei Luo; Kaizhou Jin; He Cheng; Meng Guo; Yu Lu; Zhengshi Wang; Chao Yang; Jinzhi Xu; Heli Gao; Shirong Zhang; Bo Zhang; Jiang Long; Jin Xu; Quanxing Ni; Chen Liu; Xianjun Yu

doi:10.1016/j.pan.2017.06.003

Revised nodal stage for pancreatic neuroendocrine tumors

Pancreatology. 2017 Jul-Aug;17(4):599-604. doi: 10.1016/j.pan.2017.06.003. Epub 2017 Jun 10.

Authors

Guopei Luo¹, Kaizhou Jin¹, He Cheng¹, Meng Guo¹, Yu Lu¹, Zhengshi Wang¹, Chao Yang¹, Jinzhi Xu¹, Heli Gao¹, Shirong Zhang¹, Bo Zhang¹, Jiang Long¹, Jin Xu¹, Quanxing Ni¹, Chen Liu², Xianjun Yu³

Affiliations

¹ Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
² Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China. Electronic address: liuchen@fudanpci.org.
³ Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China. Electronic address: yuxianjun88@hotmail.com.

PMID: 28610828
DOI: 10.1016/j.pan.2017.06.003

Abstract

Background: Previously we have proposed a modified European Neuroendocrine Tumor Society (mENETS) staging system for pNETs, which is more suitable than either the American Joint Committee on Cancer (AJCC) or the European Neuroendocrine Tumor Society (ENETS) systems. However, it is necessary to revise the nodal stage of the mENETS system for the under representation of stage III diseases.

Methods: Nodal substages of the upper gastrointestinal organs (N0: 0 node, N1: 1-2 nodes; N2: ≥3 nodes) or the lower gastrointestinal organs (0: 0 node, N1: 1-3 nodes, and N2:≥ 4 nodes) were incorporated into the mENETS system and evaluated using the Surveillance, Epidemiology, and End Results (SEER) registry series.

Results: The mENETS classification with the upper gastrointestinal N-stage revision (stage III, 17.1%) had better proportional distribution than the mENETS classification (stage III, 8.7%) or the lower gastrointestinal N-stage revision (stage III, 14.5%). N-stage revision (N0: 0 node, N1: 1-2 nodes; N2: ≥3 nodes) was incorporated in the mENETS staging definition for further analysis. Survival curves were well separated by nodal substages. HRs of stage IIA (T3N0M0) and IIB (T1-3N1M0) of the mENETS classification with N-stage revision were similar, indicating these two substages should be attributed to stage II. Survival curves were well separated by stage using the mENETS classification with N-stage revision.

Conclusions: The mENETS classification with N-stage revision (N0: 0 node, N1: 1-2 nodes; N2: ≥3 nodes) had better prognostic value and proportional distribution than the mENETS classification for pNETs and can be used in clinical practice.

Keywords: AJCC; ENETS; Pancreatic neuroendocrine tumor; Stage; TNM.