Published online Jul 7, 2020. doi: 10.3748/wjg.v26.i25.3638
Peer-review started: January 10, 2020
First decision: March 6, 2020
Revised: May 8, 2020
Accepted: June 9, 2020
Article in press: June 9, 2020
Published online: July 7, 2020
Pancreatic neuroendocrine neoplasms (pNENs) that produce hormones leading to symptoms are classified as functional tumors, while others are classified as nonfunctional tumors.
The traditional view is that functionality affects the prognosis of pNEN patients. However, recent studies have proposed new viewpoints. Because of the rarity of pNENs and the low proportion of functional tumors, few studies have performed multivariate Cox regression to show the effect of functionality on survival.
To assess whether functionality is an independent factor for predicting the prognosis of pNEN patients.
From January 2004 to December 2016, data of patients who underwent surgery at the primary site for the treatment of pNENs from the Surveillance, Epidemiology, and End Results (SEER) database and West China Hospital database were retrospectively analyzed.
From the SEER database, age and T stage were independent risk factors affecting the survival. From the West China Hospital database, independent prognostic factors were age, sex, and grade. The result of the cohort consisting of the combined populations from the two databases showed that race, age, sex, and T stage were independent prognostic factors. In the West China Hospital database and in the total population, nonfunctional pNETs and other functional pNETs tended to have poorer prognoses than insulinomas. However, functionality was not associated with the survival time of patients with pNETs in the multivariate analysis.
Race, age, sex, and T stage are independent factors for predicting the survival of patients with pNETs. The results of this study do not support the opinion that hormone related syndrome is an efficacious tool to classify tumors into groups with different prognoses.
Hormone related syndrome is the only basis to assess the functionality of neuroendocrine neoplasms. Nonfunctional tumors and functional tumors were reported to have different prognoses. However, they do not have much difference in pathologic feature or gene expression. Immunohistochemical staining also displays the expression of insulin/glucagon/gastrin/somatostatin in non-functional tumors. The reasonability of classification based on symptoms rather than gene expression needs to be further explored.