title: A preoperative prognostic score for resected pancreatic and periampullary neuroendocrine tumours.
abstract: OBJECTIVE
  To identify potential preoperative prognostic factors in resected pancreatic and periampullary neuroendocrine tumours.
  
  
  METHODS
  Clinico-pathological data for 54 consecutive patients with pancreatic or periampullary neuroendocrine tumours referred to our institution over a 10-year period were identified from a prospective database.
  
  
  RESULTS
  34 patients underwent pancreatic resection (12 males, 22 females; median age 54 (IQR 44-71) years). There was a single 30-day mortality (3%). Nodal status (log rank, p = 0.652), microscopic resection margin involvement (p = 0.549) and tumour size (p = 0.122) failed to exhibit any prognostic value. Only the presence of malignant tumour characteristics was associated with poorer overall survival (p = 0.008). Analysis of preoperative parameters showed that age >60 years (p = 0.056), platelet-lymphocyte ratio >300 (p = 0.008), alkaline phosphatase levels >125 U/l (p = 0.042) and alanine aminotransferase >35 U/l (p = 0.016) were adverse prognostic factors. A risk stratification score was generated where each adverse preoperative parameter was allocated a score of 1. A cumulative score of < or =1 was defined as low risk, while a score of > or =2 was defined as high risk. Median overall survival in the high-risk group was 10.4 months, while the median survival in the low-risk group was >60 months (p < 0.001).
  
  
  CONCLUSIONS
  Significant prognostic information can be gained from routine preoperative biochemistry and haematology results in resected pancreatic and periampullary neuroendocrine tumours. These findings merit further evaluation in a larger patient cohort.
authors.affiliation: Division of Surgery and Oncology, School of Cancer Studies, University of Liverpool, Liverpool, UK.
authors.forename: Nicole
authors.initials: N
authors.lastname: Sakka
authors.forename: Richard A
authors.initials: RA
authors.lastname: Smith
authors.forename: Philip
authors.initials: P
authors.lastname: Whelan
authors.forename: Paula
authors.initials: P
authors.lastname: Ghaneh
authors.forename: Robert
authors.initials: R
authors.lastname: Sutton
authors.forename: Michael
authors.initials: M
authors.lastname: Raraty
authors.forename: Fiona
authors.initials: F
authors.lastname: Campbell
authors.forename: John P
authors.initials: JP
authors.lastname: Neoptolemos
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000601:surgery*; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D010976:Platelet Count; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D000410:Alanine Transaminase; D000469:Alkaline Phosphatase