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Outcomes of Lymph Node Dissection for Non-metastatic Pancreatic Neuroendocrine Tumors: A Propensity Score-Weighted Analysis of the National Cancer Database.
Ann Surg Oncol 2019; 26(9):2722-2729AS

Abstract

BACKGROUND

Although the National Comprehensive Cancer Network (NCCN) guidelines recommend use of lymph node dissection (LND) in patients with pancreatic neuroendocrine tumors (pNETs) > 2 cm, there is limited evidence to support the association between use of LND and overall survival (OS).

METHODS

Patients with resected pNETs were identified in the National Cancer Database (2004-2014). The inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare OS of patients in different treatment groups.

RESULTS

A total of 2664 patients diagnosed met the study entry criteria. Of these, 2132 patients (80.6%) received LND, with a median of nine nodes removed. Positive nodes were identified in 28.0% of patients who underwent LND. IPTW-adjusted Kaplan-Meier analysis showed that median OS was similar between the LND and LND-omitted groups (152.8 vs. 147.3 months; p = 0.61). In IPTW-adjusted Cox proportional hazards regression analysis, LND was not associated with an OS benefit (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.94-1.42; p = 0.18). The results were consistent across subgroups stratified by clinical T and N stages. Among patients with lymph node metastasis, the number of removed nodes (NRN) above the median was not associated with an improved OS (HR 0.82, 95% CI 0.60-1.13; p = 0.22).

CONCLUSIONS

LND had no additional therapeutic benefit among patients undergoing resection for pNETs. The present findings should be considered when managing patients with resectable pNETs.

Authors+Show Affiliations

Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Merck Research Laboratory, Merck & Co, North Wales, PA, USA.Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.Department of Surgery, Duke University Medical Center, Durham, NC, USA.Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Surgery, Duke University Medical Center, Durham, NC, USA. trey.blazer@duke.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31209670

Citation

Mao, Rui, et al. "Outcomes of Lymph Node Dissection for Non-metastatic Pancreatic Neuroendocrine Tumors: a Propensity Score-Weighted Analysis of the National Cancer Database." Annals of Surgical Oncology, vol. 26, no. 9, 2019, pp. 2722-2729.
Mao R, Zhao H, Li K, et al. Outcomes of Lymph Node Dissection for Non-metastatic Pancreatic Neuroendocrine Tumors: A Propensity Score-Weighted Analysis of the National Cancer Database. Ann Surg Oncol. 2019;26(9):2722-2729.
Mao, R., Zhao, H., Li, K., Luo, S., Turner, M., Cai, J. Q., & Blazer, D. (2019). Outcomes of Lymph Node Dissection for Non-metastatic Pancreatic Neuroendocrine Tumors: A Propensity Score-Weighted Analysis of the National Cancer Database. Annals of Surgical Oncology, 26(9), pp. 2722-2729. doi:10.1245/s10434-019-07506-5.
Mao R, et al. Outcomes of Lymph Node Dissection for Non-metastatic Pancreatic Neuroendocrine Tumors: a Propensity Score-Weighted Analysis of the National Cancer Database. Ann Surg Oncol. 2019;26(9):2722-2729. PubMed PMID: 31209670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of Lymph Node Dissection for Non-metastatic Pancreatic Neuroendocrine Tumors: A Propensity Score-Weighted Analysis of the National Cancer Database. AU - Mao,Rui, AU - Zhao,Hong, AU - Li,Kan, AU - Luo,Sheng, AU - Turner,Megan, AU - Cai,Jian-Qiang, AU - Blazer,Dan,3rd Y1 - 2019/06/17/ PY - 2019/03/01/received PY - 2019/6/19/pubmed PY - 2019/6/19/medline PY - 2019/6/19/entrez SP - 2722 EP - 2729 JF - Annals of surgical oncology JO - Ann. Surg. Oncol. VL - 26 IS - 9 N2 - BACKGROUND: Although the National Comprehensive Cancer Network (NCCN) guidelines recommend use of lymph node dissection (LND) in patients with pancreatic neuroendocrine tumors (pNETs) > 2 cm, there is limited evidence to support the association between use of LND and overall survival (OS). METHODS: Patients with resected pNETs were identified in the National Cancer Database (2004-2014). The inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare OS of patients in different treatment groups. RESULTS: A total of 2664 patients diagnosed met the study entry criteria. Of these, 2132 patients (80.6%) received LND, with a median of nine nodes removed. Positive nodes were identified in 28.0% of patients who underwent LND. IPTW-adjusted Kaplan-Meier analysis showed that median OS was similar between the LND and LND-omitted groups (152.8 vs. 147.3 months; p = 0.61). In IPTW-adjusted Cox proportional hazards regression analysis, LND was not associated with an OS benefit (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.94-1.42; p = 0.18). The results were consistent across subgroups stratified by clinical T and N stages. Among patients with lymph node metastasis, the number of removed nodes (NRN) above the median was not associated with an improved OS (HR 0.82, 95% CI 0.60-1.13; p = 0.22). CONCLUSIONS: LND had no additional therapeutic benefit among patients undergoing resection for pNETs. The present findings should be considered when managing patients with resectable pNETs. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/31209670/Outcomes_of_Lymph_Node_Dissection_for_Non-metastatic_Pancreatic_Neuroendocrine_Tumors:_A_Propensity_Score-Weighted_Analysis_of_the_National_Cancer_Database L2 - https://dx.doi.org/10.1245/s10434-019-07506-5 DB - PRIME DP - Unbound Medicine ER -