title: Treatment Response and Outcomes of Grade 3 Pancreatic Neuroendocrine Neoplasms Based on Morphology: Well Differentiated Versus Poorly Differentiated.
abstract: Emerging data suggest that not all grade 3 (G3) pancreatic neuroendocrine neoplasms (panNENs) behave the same; tumor differentiation may predict outcome.
  
  
  
  Patients with G3 panNENs treated at our institution between 1999 and 2014 were identified. Demographics, response to therapy, and overall survival were determined.
  
  
  
  Forty-five patients were identified, 16 with G3 well differentiated pancreatic neuroendocrine tumors (WD-panNETs) and 29 with poorly differentiated neuroendocrine carcinomas (PDNEC). Median overall survival in G3 WD-panNET patients was 52.2 months (95% confidence interval, 19.3-86.9 months) compared with 10.1 months (95% confidence interval, 6.9-12.4 months) in PDNEC patients (P = 0.0009). Response rate to platinum agents was 10% in G3 WD-panNETs and 37% in PDNEC. Response rate to alkylating agents was 50% in G3 WD-panNETs and 50% in PDNEC.
  
  
  
  Both G3 WD-panNETs and PDNEC responded to platinum and alkylating agents. Overall survival was significantly greater in G3 WD-panNETs compared with PDNEC. These findings challenge current classification and suggest that G3 panNENs should be classified by morphology.
authors.affiliation: From the Departments of *Medicine, †Biostatistics, ‡Pathology, and §Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Nitya
authors.initials: N
authors.lastname: Raj
authors.forename: Emily
authors.initials: E
authors.lastname: Valentino
authors.forename: Marinela
authors.initials: M
authors.lastname: Capanu
authors.forename: Laura H
authors.initials: LH
authors.lastname: Tang
authors.forename: Olca
authors.initials: O
authors.lastname: Basturk
authors.forename: Brian R
authors.initials: BR
authors.lastname: Untch
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: David S
authors.initials: DS
authors.lastname: Klimstra
authors.forename: Diane
authors.initials: D
authors.lastname: Reidy-Lagunes
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018278:Carcinoma, Neuroendocrine / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D018358:Neuroendocrine Tumors / Q000188:drug therapy* / Q000473:pathology; D010179:Pancreas / Q000187:drug effects / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome