Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems
- 20 January 2017
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 35 (3), 274-280
- https://doi.org/10.1200/jco.2016.67.8193
Abstract
Purpose The European Neuroendocrine Tumor Society (ENETS) and the American Joint Committee on Cancer (AJCC) staging classifications are two widely used systems in managing pancreatic neuroendocrine tumors. However, there is no universally accepted system. Methods An analysis was performed to evaluate the application of the ENETS and AJCC staging classifications using the SEER registry (N = 2,529 patients) and a multicentric series (N = 1,143 patients). A modified system was proposed based on analysis of the two existing classifications. The modified system was then validated. Results The proportion of patients with AJCC stage III disease was extremely low for both the SEER series (2.2%) and the multicentric series (2.1%). For the ENETS staging system, patients with stage I disease had a similar prognosis to patients with stage IIA disease, and patients with stage IIIB disease had a lower hazard ratio for death than did patients with stage IIIA disease. We modified the ENETS staging classification by maintaining the ENETS T, N, and M definitions and adopting the AJCC staging definitions. The proportion of patients with stage III disease using the modified ENETS (mENETS) system was higher than that of the AJCC system in both the SEER series (8.9% v 2.2%) and the multicentric series (11.6% v 2.1%). In addition, the hazard ratio of death for patients with stage III disease was higher than that for patients with stage IIB disease. Moreover, statistical significance and proportional distribution were observed in the mENETS staging classification. Conclusion An mENETS staging classification is more suitable for pancreatic neuroendocrine tumors than either the AJCC or ENETS systems and can be adopted in clinical practice.This publication has 16 references indexed in Scilit:
- Functional malignant cell heterogeneity in pancreatic neuroendocrine tumors revealed by targeting of PDGF-DDProceedings of the National Academy of Sciences of the United States of America, 2016
- Recommendations for management of patients with neuroendocrine liver metastasesThe Lancet Oncology, 2014
- TNM Staging of Neoplasms of the Endocrine Pancreas: Results From a Large International Cohort StudyJNCI Journal of the National Cancer Institute, 2012
- Metastatic and Locally Advanced Pancreatic Endocrine Carcinomas: Analysis of Factors Associated With Disease ProgressionJournal of Clinical Oncology, 2011
- The ENETS and AJCC/UICC TNM classifications of the neuroendocrine tumors of the gastrointestinal tract and the pancreas: a statementVirchows Archiv A Pathological Anatomy and Histopathology, 2010
- Improved histologic and clinicopathologic criteria for prognostic evaluation of pancreatic endocrine tumorsHuman Pathology, 2009
- One Hundred Years After “Carcinoid”: Epidemiology of and Prognostic Factors for Neuroendocrine Tumors in 35,825 Cases in the United StatesJournal of Clinical Oncology, 2008
- Clinical outcome and long-term survival in 118 consecutive patients with neuroendocrine tumours of the pancreasBritish Journal of Surgery, 2008
- Application of the Pancreatic Adenocarcinoma Staging System to Pancreatic Neuroendocrine TumorsJournal of the American College of Surgeons, 2007
- TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading systemVirchows Archiv, 2006