A Preoperative Clinical Risk Score Including C-Reactive Protein Predicts Histological Tumor Characteristics and Patient Survival after Surgery for Sporadic Non-Functional Pancreatic Neuroendocrine Neoplasms: An International Multicenter Cohort Study

被引：15

作者：

Primavesi, Florian ^{[1
]}

Andreasi, Valentina ^{[2
]}

Hoogwater, Frederik J. H. ^{[3
]}

Partelli, Stefano ^{[2
]}

Wiese, Dominik ^{[4
]}

Heidsma, Charlotte ^{[5
]}

Cardini, Benno ^{[1
]}

Klieser, Eckhard ^{[6
]}

Marsoner, Katharina ^{[7
]}

Froeschl, Uwe ^{[8
]}

Thalhammer, Sabine ^{[9
]}

Fischer, Ines ^{[8
]}

Goebel, Georg ^{[10
]}

Hauer, Andreas ^{[11
]}

Kiesslich, Tobias ^{[12
]}

Ellmerer, Philipp ^{[13
]}

Klug, Reinhold ^{[11
]}

Neureiter, Daniel ^{[6
]}

Wundsam, Helwig ^{[8
]}

Sellner, Franz ^{[9
]}

Kornprat, Peter ^{[7
]}

Fuegger, Reinhold ^{[8
]}

Oefner, Dietmar ^{[1
]}

van Dijkum, Elisabeth J. M. Nieveen ^{[5
]}

Bartsch, Detlef K. ^{[4
]}

de Kleine, Ruben H. J. ^{[3
]}

Falconi, Massimo ^{[2
]}

Staettner, Stefan ^{[1
]}

机构：

[1] Med Univ Innsbruck, Dept Visceral Transplant & Thorac Surg, A-6020 Innsbruck, Austria

[2] Univ Vita Salute, IRCCS Hosp San Raffaele, Pancreat Surg, I-20132 Milan, Italy

[3] Univ Groningen, Univ Med Ctr Groningen, Dept Surg, NL-9713 GZ Groningen, Netherlands

[4] Univ Hosp Marburg, Dept Visceral Thorac & Vasc Surg, D-35043 Marburg, Germany

[5] Univ Amsterdam, Amsterdam UMC, Canc Ctr Amsterdam, Dept Surg, NL-1105 AZ Amsterdam, Netherlands

[6] Paracelsus Med Univ, Inst Pathol, A-5020 Salzburg, Austria

[7] Med Univ Graz, Dept Surg, A-8036 Graz, Austria

[8] Ordensklinikum, Dept Surg, A-4010 Linz, Austria

[9] Kaiser Franz Josef Hosp, Dept Surg, A-1100 Vienna, Austria

[10] Med Univ Innsbruck, Dept Med Stat Informat & Hlth Econ, A-6020 Innsbruck, Austria

[11] Gen Hosp Horn, Dept Surg, A-3580 Horn, Austria

[12] Paracelsus Med Univ, Inst Physiol & Pathophysiol, A-5020 Salzburg, Austria

[13] Med Univ Innsbruck, Dept Neurol, A-6020 Innsbruck, Austria

来源：

CANCERS | 2020年 / 12卷 / 05期

关键词：

pancreatic neuroendocrine tumors; C-reactive protein; risk score; neuroendocrine neoplasms; pancreas; surgery; survival; SYSTEMIC INFLAMMATORY RESPONSE; GLASGOW PROGNOSTIC SCORE; SURGICAL COMPLICATIONS; CLASSIFICATION; CANCER; EPIDEMIOLOGY; GUIDELINES; DIAGNOSIS; EFFICACY; PROPOSAL;

D O I：

10.3390/cancers12051235

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) is highly variable depending on various factors. Risk stratification with preoperatively available parameters could guide decision-making in multidisciplinary treatment concepts. C-reactive Protein (CRP) is linked to inferior survival in several malignancies. This study assesses CRP within a novel risk score predicting histology and outcome after surgery for sporadic non-functional panNENs. Methods: A retrospective multicenter study with national exploration and international validation. CRP and other factors associated with overall survival (OS) were evaluated by multivariable cox-regression to create a clinical risk score (CRS). Predictive values regarding OS, disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by time-dependent receiver-operating characteristics. Results: Overall, 364 patients were included. Median CRP was significantly higher in patients >60 years, G3, and large tumors. In multivariable analysis, CRP was the strongest preoperative factor for OS in both cohorts. In the combined cohort, CRP (cut-off >= 0.2 mg/dL; hazard-ratio (HR):3.87), metastases (HR:2.80), and primary tumor size >= 3.0 cm (HR:1.83) showed a significant association with OS. A CRS incorporating these variables was associated with postoperative histological grading, T category, nodal positivity, and 90-day morbidity/mortality. Time-dependent area-under-the-curve at 60 months for OS, DSS, and RFS was 69%, 77%, and 67%, respectively (all p < 0.001), and the inclusion of grading further improved the predictive potential (75%, 84%, and 78%, respectively). Conclusions: CRP is a significant marker of unfavorable oncological characteristics in panNENs. The proposed internationally validated CRS predicts histological features and patient survival.

引用

页数：15