PMID- 28257328
OWN - NLM
STAT- MEDLINE
DCOM- 20190809
LR  - 20190809
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 267
IP  - 6
DP  - 2018 Jun
TI  - Management of MEN1 Related Nonfunctioning Pancreatic NETs: A Shifting Paradigm: 
      Results From the DutchMEN1 Study Group.
PG  - 1155-1160
LID - 10.1097/SLA.0000000000002183 [doi]
AB  - OBJECTIVE: To assess if surgery for Multiple Endocrine Neoplasia type 1 (MEN1) 
      related nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs) is effective 
      for improving overall survival and preventing liver metastasis. BACKGROUND: MEN1 
      leads to multiple early-onset NF-pNETs. The evidence base for guiding the 
      difficult decision who and when to operate is meager. METHODS: MEN1 patients 
      diagnosed with NF-pNETs between 1990 and 2014 were selected from the DutchMEN1 
      Study Group database, including > 90% of the Dutch MEN1 population. The effect of 
      surgery was estimated using time-dependent Cox analysis with propensity score 
      restriction and adjustment. RESULTS: Of the 152 patients, 53 underwent surgery 
      and 99 were managed by watchful waiting. In the surgery group, tumors were larger 
      and faster-growing, patients were younger, more often male, and were more often 
      treated in centers that operated more frequently. Surgery for NF-pNETs was not 
      associated with a significantly lower risk of liver metastases or death, 
      [adjusted hazard ratio (HR) = 0.73 (0.25-2.11)]. Adjusted HR's after 
      stratification by tumor size were: NF-pNETs <2 cm = 2.04 (0.31-13.59) and 
      NF-pNETs 2-3 cm = 1.38 (0.09-20.31). Five out of the 6 patients with NF-pNETs 
      >3 cm managed by watchful waiting developed liver metastases or died compared 
      with 6 out of the 16 patients who underwent surgery. CONCLUSIONS: MEN1 patients 
      with NF-pNETs <2 cm can be managed by watchful waiting, hereby avoiding major 
      surgery without loss of oncological safety. The beneficial effect of a surgery in 
      NF-pNETs 2 to 3 cm requires further research. In patients with NF-pNETs >3 cm, 
      watchful waiting seems not advisable.
FAU - Nell, Sjoerd
AU  - Nell S
AD  - Department of Endocrine Surgical Oncology and Endocrine Oncology, University 
      Medical Center Utrecht, Utrecht, The Netherlands.
FAU - Verkooijen, Helena M
AU  - Verkooijen HM
AD  - Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands.
FAU - Pieterman, Carolina R C
AU  - Pieterman CRC
AD  - Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The 
      Netherlands.
FAU - de Herder, Wouter W
AU  - de Herder WW
AD  - Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The 
      Netherlands.
FAU - Hermus, Ad R
AU  - Hermus AR
AD  - Department of Endocrinology, Radboud University Medical Center, Nijmegen, The 
      Netherlands.
FAU - Dekkers, Olaf M
AU  - Dekkers OM
AD  - Departments of Endocrinology and Metabolism and Clinical Epidemiology, Leiden 
      University Medical Center, Leiden, The Netherlands.
FAU - van der Horst-Schrivers, Anouk N
AU  - van der Horst-Schrivers AN
AD  - Department of Endocrinology, University of Groningen, University Medical Center 
      Groningen, Groningen, The Netherlands.
FAU - Drent, Madeleine L
AU  - Drent ML
AD  - Department of Internal Medicine, Section of Endocrinology, VU University Medical 
      Center, Amsterdam, The Netherlands.
FAU - Bisschop, Peter H
AU  - Bisschop PH
AD  - Department of Endocrinology and Metabolism, Academic Medical Center, Amsterdam, 
      The Netherlands.
FAU - Havekes, Bas
AU  - Havekes B
AD  - Department of Internal Medicine, Division of Endocrinology, Maastricht University 
      Medical Center, Maastricht, The Netherlands.
FAU - Borel Rinkes, Inne H M
AU  - Borel Rinkes IHM
AD  - Department of Endocrine Surgical Oncology, University Medical Center Utrecht, 
      Utrecht, The Netherlands.
FAU - Vriens, Menno R
AU  - Vriens MR
AD  - Department of Endocrine Surgical Oncology, University Medical Center Utrecht, 
      Utrecht, The Netherlands.
FAU - Valk, Gerlof D
AU  - Valk GD
AD  - Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The 
      Netherlands.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
RN  - Non functioning pancreatic endocrine tumor
MH  - Adult
MH  - Female
MH  - Humans
MH  - Liver Neoplasms/prevention & control/secondary
MH  - Male
MH  - Multiple Endocrine Neoplasia Type 1/complications/pathology/*surgery
MH  - Pancreatic Neoplasms/complications/pathology/*surgery
MH  - Proportional Hazards Models
MH  - Watchful Waiting
EDAT- 2017/03/04 06:00
MHDA- 2019/08/10 06:00
CRDT- 2017/03/04 06:00
PHST- 2017/03/04 06:00 [pubmed]
PHST- 2019/08/10 06:00 [medline]
PHST- 2017/03/04 06:00 [entrez]
AID - 10.1097/SLA.0000000000002183 [doi]
PST - ppublish
SO  - Ann Surg. 2018 Jun;267(6):1155-1160. doi: 10.1097/SLA.0000000000002183.