title: Analysis of 6,747 pancreatic neuroendocrine tumors for a proposed staging system.
abstract: OBJECTIVE
  Currently, no reasonable staging system exists for pancreatic neuroendocrine tumors (PNET) to guide treating physicians. The aim of this study was to devise a staging system of relevant prognostic factors to better predict overall survival in PNET.
  
  
  METHODS
  A prospective 300 patient cohort and a review of the Surveillance Epidemiology and End Results database identified 6,447 patients with PNET from 1973 to 2008. Significant prognostic factors were created for an initial. Tumor: T (T1: ≤3 cm and localized to pancreas, T2: >3 cm and localized to the pancreas; T3: extension to adjacent organs and vessels), grade: G (G1: well/moderate and G2: poor/undifferentiated), and metastasis: M (M0: no distant mets, M1: distant mets) staging system.
  
  
  RESULTS
  Significant predictors of survival on multivariate analysis included age, size, grade, and metastasis. Based on the TGM staging system: stage 1 (T1-2, G1, M0), stage 2 (T1-2, G2, M0), stage 3 (T3G2M0, Tany, G1, M1), stage 4: (Tany, G2, M1) was created with survival being statistically different between stages (p < 0.0001). Median survival rates were stage 1, 55 months; stage 2, 50 months; stage 3, 46 months; and stage 4, 25 months.
  
  
  CONCLUSIONS
  Incorporation of this newly developed staging system into clinical practice will improve the ability to predict prognosis and aid in stratification of patients for clinical trials.
authors.affiliation: Department of Surgery, University of Louisville Hospital, Louisville, KY, USA. rcmart03@gwise.louisville.edu
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.forename: Nipun B
authors.initials: NB
authors.lastname: Merchant
authors.forename: Alex A
authors.initials: AA
authors.lastname: Parikh
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: William
authors.initials: W
authors.lastname: Hawkins
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult