title: Treatment of malignant pancreatic neuroendocrine neoplasms: middle-term (2-year) outcomes of a prospective observational multicentre study.
abstract: BACKGROUND
  Information on malignant pancreatic neuroendocrine neoplasms (pNENs) is mostly from retrospective studies in highly selected patients. The aim of this prospective, multicentre study was to assess treatment and outcomes of malignant pNENs in clinical practice.
  
  
  METHODS
  Consecutive patients with newly diagnosed, histologically-proven pNENs were included and followed-up for 2 years. Tumours were defined as malignant when nodal or distant metastases were present or invasion of extrapancreatic structures/organs was evident.
  
  
  RESULTS
  A total of 140 patients with malignant pNENs were included. Ninety-eight patients (70.0%) underwent a surgical resection (76 radical and 22 palliative). Other non-surgical treatments were used in 101 patients (72.1%): somatostatin analogues (n = 63), chemotherapy (n = 30), ablative treatments (n = 15) and peptide-receptor radionuclide therapy (n = 14). No relationship was observed between the 2010 WHO classification and type of treatment. A surgical resection was more often performed in incidentally detected tumours located in the pancreas body tail. Two-year progression-free survival was 63.8%: 82% after a radical resection, 44% after a palliative resection and 41% without a resection. A radical resection and Ki67 proliferative index >5% and >10% were the only significant prognostic determinants in multivariate analysis.
  
  
  CONCLUSIONS
  A radical resection is the cornerstone treatment of malignant pNENs and represents, together with Ki67 assessment, the most powerful prognostic factor for 2-year outcomes.
authors.affiliation: Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zerbi
authors.forename: Vanessa
authors.initials: V
authors.lastname: Capitanio
authors.forename: Letizia
authors.initials: L
authors.lastname: Boninsegna
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Delle Fave
authors.forename: Claudio
authors.initials: C
authors.lastname: Pasquali
authors.forename: Guido
authors.initials: G
authors.lastname: Rindi
authors.forename: Davide
authors.initials: D
authors.lastname: Campana
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D049109:Cell Proliferation; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy; D019394:Ki-67 Antigen / Q000032:analysis; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000737:chemistry / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D010166:Palliative Care; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018579:Patient Selection; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D019394:Ki-67 Antigen; D019275:Radiopharmaceuticals