title: Surgical Treatment as a Principle for Patients with High-Grade Pancreatic Neuroendocrine Carcinoma: A Nordic Multicenter Comparative Study.
abstract: BACKGROUND
  This study aimed to evaluate the role of surgery for patients with high-grade pancreatic neuroendocrine carcinoma (hgPNEC) in a large Nordic multicenter cohort study. Prior studies evaluating the role of surgery for patients with hgPNEC are limited, and the benefit of the surgery is uncertain.
  
  
  METHODS
  Data from patients with a diagnosis of hgPNEC determined between 1998 and 2012 were retrospectively registered at 10 Nordic university hospitals. Kaplan-Meier curves were used to compare the overall survival of different treatment groups, and Cox-regression analysis was used to evaluate factors potentially influencing survival.
  
  
  RESULTS
  The study registered 119 patients. The median survival period from the time of metastasis was 23 months for patients undergoing initial resection of localized nonmetastatic disease and chemotherapy at the time of recurrence (n = 14), 29 months for patients undergoing resection of the primary tumor and resection/radiofrequency ablation of synchronous metastatic liver disease (n = 12), and 13 months for patients with synchronous metastatic disease given systemic chemotherapy alone (n = 78). The 3-year survival rate after surgery of the primary tumor and metastatic disease was 69 %. Resection of the primary tumor was an independent factor for improved survival after occurrence of metastatic disease.
  
  
  CONCLUSIONS
  Patients with resected localized nonmetastatic hgPNEC and later metastatic disease seemed to benefit from initial resection of the primary tumor. Patients selected for resection of the primary tumor and synchronous liver metastases had a high 3-year survival rate. Selected patients with both localized hgPNEC and metastatic hgPNEC should be considered for radical surgical treatment.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway. sphaugvik@yahoo.de.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway. sphaugvik@yahoo.de.
authors.forename: Sven-Petter
authors.initials: SP
authors.lastname: Haugvik
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Eva Tiensuu
authors.initials: ET
authors.lastname: Janson
authors.affiliation: Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Österlund
authors.affiliation: Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Seppo W
authors.initials: SW
authors.lastname: Langer
authors.affiliation: Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Ragnhild Sørum
authors.initials: RS
authors.lastname: Falk
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Knut Jørgen
authors.initials: KJ
authors.lastname: Labori
authors.affiliation: Department of Oncology, Odense University Hospital, Odense C, Denmark.
authors.forename: Lene Weber
authors.initials: LW
authors.lastname: Vestermark
authors.affiliation: Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Grønbæk
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Ivar Prydz
authors.initials: IP
authors.lastname: Gladhaug
authors.affiliation: Department of Oncology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Halfdan
authors.initials: H
authors.lastname: Sorbye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018278:Carcinoma, Neuroendocrine / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012537:Scandinavian and Nordic Countries; D015996:Survival Rate; D055815:Young Adult