Outcomes of Primary Tumor Resection in Patients with Stage IV Pancreatic Neuroendocrine Neoplasms: A Population-Based Survival Analysis

Abstract

Abstract Background. Evidence is limited supporting the use of primary tumor resection (PTR) for metastasized pancreatic neuroendocrine neoplasms (pNENs). Methods. The Surveillance, Epidemiology, and End Results (SEER) dataset was queried for patients with stage IV pNENs. Landmark analysis was performed to elinimate guarantee-time bias. Cox proportional hazards regression analyses and propensity-score matching (PSM) were performed to compare overall survival (OS) and cancer-specific survival (CSS) of patients who received PTR versus no tumor resection (NTR). Results. Of the 623 patients enrolled, 280 (44.9%) received PTR. Synchronous presentations of varied treatment paradigms revealed surgical intervention significantly increased OS and CSS. PSM analyses revealed improved OS and CSS among patients receiving PTR versus NTR (OS: 53 versus 27months, p<0.0001; CSS: 71versus 27 months, p<0.0001). The subgroup analysis demonstrated that the elevated OS was associated with PTR (versus NTR) within subgroups including male, white, T1-3, location except for pancreatic body and Msite 1. The recursive partitioning analysis (RPA) analysis demonstrated Grade I-II (low-risk) and Grade III-IV with Msite 1 (intermediate-risk) but not Grade III-IV with Msite 0 or ≥2 (high-risk) were connected with OS benefits. Conclusion. PTR improves OS and CSS in metastasized pNENs, provided that these surgical candidates are appropriately selected.