J Cancer 2018; 9(9):1698-1706. doi:10.7150/jca.24178

Research Paper

The latest exploration of staging and prognostic classification for pancreatic neuroendocrine tumors: a large population-based study

Shanshan Gao1,2*, Ning Pu3*, Lingxiao Liu1,2, Changyu Li1,2, Xuefeng Xu3, Xiaolin Wang1,2✉, Wenhui Lou3✉

1. Shanghai Institute of Medical Imaging, Shanghai, 200032, People's Republic of China
2. Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
3. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
*These authors contributed equally to this work

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Citation:
Gao S, Pu N, Liu L, Li C, Xu X, Wang X, Lou W. The latest exploration of staging and prognostic classification for pancreatic neuroendocrine tumors: a large population-based study. J Cancer 2018; 9(9):1698-1706. doi:10.7150/jca.24178. Available from http://www.jcancer.org/v09p1698.htm

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Abstract

Background: A modified European Neuroendocrine Tumor Society (mENETS) staging system has been confirmed to be more suitable for pancreatic neuroendocrine tumors (pNETs) when compared to the American Joint Committee on Cancer (AJCC) or the European Neuroendocrine Tumor Society (ENETS) systems in the last few years. However, the importance of N stage has been recently published with several significant updates.

Methods: SEER registry (n = 2,209) was used to evaluate the application of the AJCC 7th staging system, ENETS staging system, mENETS staging system and reformed ENETS (rENETS) staging system in this study.

Results: For the ENETS staging system, patients with stage I disease had a similar prognosis to patients with stage II disease (P=0.154), and patients with stage IIIA and stage IIIB diseases showed adverse prognostic potential. The proportion of patients with stage III diseases using AJCC 7th staging system was extremely lower than those with mENETS staging system or rENETS staging system (3.6%, 23.0% and 23.7%, respectively). Furthermore, the hazard ratio of death for patients with stage II or III disease using rENETS staging system was slightly higher than that of mENETS staging system. Besides, survival curves were better separated by rENETS staging system. A prognostic nomogram for overall survival (OS) was formulated to obtain superior discriminatory abilities.

Conclusions: The rENETS staging system has superior distribution in proportion than the AJCC 7th, ENETS or mENETS staging system, and one more accurate and advanced predictive model will be achieved via the incorporation to be adopted in clinical practice.

Keywords: rENETS, mENETS, pancreatic neuroendocrine tumor, nomogram, decision curve analysis