title: Ki-67 predicts disease recurrence and poor prognosis in pancreatic neuroendocrine neoplasms.
abstract: BACKGROUND
  Pancreatic neuroendocrine neoplasms are rare malignancies for which the ideal staging method remains controversial. Ki-67 is a cell proliferation marker that has been shown to have some utility in predicting prognosis in neuroendocrine neoplasms. We sought to test the predictive ability of Ki-67 staining for disease recurrence and overall survival (OS) in pancreatic neuroendocrine neoplasms.
  
  
  METHODS
  The medical records of patients who underwent pancreatic resection for pancreatic neuroendocrine neoplasms at a tertiary referral hospital from 1994 to 2009 were reviewed. The pathologic specimens of all were stained for Ki-67 and recorded as percentage of cells staining positive per high-powered field. The 10-year disease-free and OSs were analyzed.
  
  
  RESULTS
  We identified 140 patients. Gender and age were not associated with increased risk of disease recurrence. Patients with tumors >4 cm or with Ki-67 staining >9% were more likely to have disease recurrence (P = .0454 and .047) and have decreased OS (P < .0001 and .0007).
  
  
  CONCLUSIONS
  Increasing tumor size and increasing Ki-67 staining both correlate with increased risk of disease recurrence and decreased OS. Designing a staging system that incorporates both of these clinical variables will enable better identification of patients at risk for recurrent pancreatic neuroendocrine neoplasms.
authors.affiliation: Department of Surgery, Washington University, Saint Louis, MO, USA.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Hamilton
authors.forename: Ta-Chiang
authors.initials: TC
authors.lastname: Liu
authors.forename: Antonino
authors.initials: A
authors.lastname: Cavatiao
authors.forename: Kareem
authors.initials: K
authors.lastname: Mawad
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.forename: Steven S
authors.initials: SS
authors.lastname: Strasberg
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
authors.forename: Dengfeng
authors.initials: D
authors.lastname: Cao
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D018278:Carcinoma, Neuroendocrine / Q000378:metabolism* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen