Little research is available regarding the treatments combining surgical resection with systemic
chemotherapy for advanced pancreatic neuroendocrine
neoplasm patients. We retrospectively elucidated whether
sunitinib administration before surgery in advanced pancreatic neuroendocrine
neoplasm (Pan-NEN) patients increases survival.
METHODS: This study included 106 of 326 Pan-NEN patients with distant
metastases and/or unresectable locally advanced
tumors who visited our department to receive
sunitinib for more than 1 mo during April 2002 to December 2019. Risk factors for overall survival (OS) and disease-free survival (DFS) were analyzed.
RESULTS: The median duration of preoperative
sunitinib administration and observation time after
sunitinib were 6 and 26.5 mo, respectively. Of 106 patients, 31 (29.2%) underwent surgery following
sunitinib administration.
Hepatectomy, synchronous hepatopancreatectomy,
pancreatectomy, and
lymphadenectomy were performed for 13, 12, 5, and 1 patient, respectively. The 5-y OS rates in the resected and nonresected groups were 88.9% and 14.1%, respectively (P < .001). In the multivariate analysis, the absence of surgical resection following
sunitinib (hazard ratio [HR], 13.1; P = .001), poor differentiation (HR, 5.5; P = .007), and bilateral liver
metastases (HR, 3.7; P = .048) were independent risk factors for OS, although large liver
tumor volumes were more evident in the nonresected group, as patient characteristics. The median DFS was 16.1 mo in 22 patients who underwent R0/1 resections, and risk factors for postoperative recurrence were Ki-67 index >7.8% (HR, 7.4; P = .02) and R1 resection (HR, 4.4; P = .04).
CONCLUSION: