Summary
Objective: Current staging systems are not accurate for classifying pancreatic endocrine tumors
(PETs) by risk. Here, we developed a prognostic model for PETs and compared it to
the WHO classification system.
Methods: We identified 98 patients diagnosed with PET at NewYork-Presbyterian Hospital/Columbia
University Medical Center (1999 to 2009). Tumor and clinical characteristics were
retrieved and associations with survival were assessed by univariate Cox analysis.
A multivariable model was constructed and a risk score was calculated; the prognostic
strength of our model was assessed with the concordance index.
Results: Our cohort had median age of 60 years and consisted of 61.2% women; median follow-up
time was 10.4 months (range: 0.1-99.6) with a 5-year survival of 61.5%. The majority
of PETs were non-functional and no difference was observed between functional and
non-functional tumors with respect to WHO stage, age, pathologic characteristics or
survival. Distant metastases, aspartate aminotransferase-AST and surgical resection
(HR=3.39, 95% CI: 1.38-8.35, p=0.008, HR=3.73, 95% CI: 1.20-11.57, p=0.023 and HR=0.20,
95% CI: 0.08-0.51, p<0.001 respectively) were the strongest predictors in the univariate
analysis. Age, perineural and/or lymphovascular invasion, distant metastases and AST
were the independent prognostic factors in the final multivariable model; a risk score
was calculated and classified patients into low (n=40), intermediate (n=48) and high
risk (n=10) groups. The concordance index of our model was 0.93 compared to 0.72 for
the WHO system.
Conclusion: Our prognostic model was highly accurate in stratifying patients by risk; novel approaches
as such could thus be incorporated into clinical decisions.
Keywords
Data repositories - Data mining - Pancreatic endocrine tumors - Prognosis - Electronic
health records
