title: Differences and Similarities in the Clinicopathological Features of Pancreatic Neuroendocrine Tumors in China and the United States: A Multicenter Study.
abstract: The presentation, pathology, and prognosis of pancreatic neuroendocrine tumors (PNETs) in Asian patients have not been studied in large cohorts. We hypothesized that the clinicopathological features of PNETs of Chinese patients might be different from those of US patients. The objectives of this study were to address whether PNETs in Chinese patients exhibit unique clinicopathological features and natural history, and can be graded and staged using the WHO/ENETS criteria. This is a retrospective review of medical records of patients with PNETs in multiple academic medical centers in China (7) and the United States (2). Tumor grading and staging were based on WHO/ENETS criteria. The clinicopathological features of PNETs of Chinese and US patients were compared. Univariate and multivariate analyses were performed to find associations between survival and patient demographics, tumor grade and stage, and other clinicopathological characteristics. A total of 977 (527 Chinese and 450 US) patients with PNETs were studied. In general, Chinese patients were younger than US patients (median age 46 vs 56 years). In Chinese patients, insulinomas were the most common (52.2%), followed by nonfunctional tumors (39.7%), whereas the order was reversed in US patients. Tumor grade distribution was similar in the 2 countries (G1: 57.5% vs 55.0%; G2: 38.5% vs 41.3%; and G3: 4.0% vs 3.7%). However, age, primary tumor size, primary tumor location, grade, and stage of subtypes of PNETs were significantly different between the 2 countries. The Chinese nonfunctional tumors were significantly larger than US ones (median size 4 vs 3 cm) and more frequently located in the head/neck region (54.9% vs 34.8%). The Chinese and US insulinomas were similar in size (median 1.5 cm) but the Chinese insulinomas relatively more frequently located in the head/neck region (48.3% vs 26.1%). Higher grade, advanced stage, metastasis, and larger primary tumor size were significantly associated with unfavorable survival in both countries. Several clinicopathological differences are found between Chinese and US PNETs but the PNETs of both countries follow a similar natural history. The WHO tumor grading and ENETS staging criteria are applicable to both Chinese and US patients.
authors.affiliation: From the Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing (L-MZ, X-WQ, Y-LS, T-TS, C-ML, Y-JC); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (LT); Markey Cancer Center, University of Kentucky, Lexington, KY (EW); Department of Surgery (NNN); Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA (DD); Department of Gastroenterology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou (JC); Department of Gastrointestinal Medical Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute (LS); Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (YC); Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai (Y-ZY, Q-WB); Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou (BL); Department of Endocrinology, the Third Hospital of Hebei Medical University, Shijiazhuang (Y-RZ); Department of Oncology (C-MB); Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing (JC); and Division of Endocrinology and Carcinoid and Neuroendocrine Tumor Center, Cedars-Sinai Medical Center, University of California Los Angeles, Los Angeles, CA (RY).
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Zhu
authors.forename: Laura
authors.initials: L
authors.lastname: Tang
authors.forename: Xin-Wei
authors.initials: XW
authors.lastname: Qiao
authors.forename: Edward
authors.initials: E
authors.lastname: Wolin
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Nissen
authors.forename: Deepti
authors.initials: D
authors.lastname: Dhall
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Lin
authors.initials: L
authors.lastname: Shen
authors.forename: Yihebali
authors.initials: Y
authors.lastname: Chi
authors.forename: Yao-Zong
authors.initials: YZ
authors.lastname: Yuan
authors.forename: Qi-Wen
authors.initials: QW
authors.lastname: Ben
authors.forename: Bin
authors.initials: B
authors.lastname: Lv
authors.forename: Ya-Ru
authors.initials: YR
authors.lastname: Zhou
authors.forename: Chun-Mei
authors.initials: CM
authors.lastname: Bai
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Song
authors.forename: Tian-Tian
authors.initials: TT
authors.lastname: Song
authors.forename: Chong-Mei
authors.initials: CM
authors.lastname: Lu
authors.forename: Run
authors.initials: R
authors.lastname: Yu
authors.forename: Yuan-Jia
authors.initials: YJ
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000453:epidemiology / Q000473:pathology*; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult