1. Management of MEN1 Related Nonfunctioning Pancreatic NETs
- Author
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Helena M. Verkooijen, Olaf M. Dekkers, Inne H.M. Borel Rinkes, Sjoerd Nell, Peter H. Bisschop, Anouk N A van der Horst-Schrivers, Bas Havekes, Menno R. Vriens, Ad R. M. M. Hermus, Wouter W. de Herder, Madeleine L. Drent, Carolina R. C. Pieterman, Gerlof D. Valk, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Endocrinology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Internal Medicine, Clinical Neuropsychology, IBBA, RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, MUMC+: MA Endocrinologie (9), Interne Geneeskunde, Internal medicine, and AGEM - Endocrinology, metabolism and nutrition
- Subjects
Male ,medicine.medical_treatment ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Neuroendocrine tumors ,GUIDELINES ,multiple endocrine neoplasia type 1 ,surgery ,0302 clinical medicine ,Non-U.S. Gov't ,Multiple endocrine neoplasia ,ENDOCRINE NEOPLASIA TYPE-1 ,education.field_of_study ,Research Support, Non-U.S. Gov't ,Hazard ratio ,Liver Neoplasms ,DEATH ,Pancreatic Neoplasms/complications ,PROPENSITY SCORE ,030220 oncology & carcinogenesis ,Multiple endocrine neoplasia type 1 ,oncology ,Female ,Adult ,medicine.medical_specialty ,Population ,030209 endocrinology & metabolism ,Research Support ,Lower risk ,Liver Neoplasms/prevention & control ,survival ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,medicine ,Journal Article ,Humans ,education ,Watchful Waiting ,Pancreatic neuroendocrine tumors ,Proportional Hazards Models ,pancreatic neuroendocrine tumors ,Proportional hazards model ,business.industry ,GTE ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Multiple Endocrine Neoplasia Type 1/complications ,Propensity score matching ,business ,Watchful waiting ,NEUROENDOCRINE TUMORS - Abstract
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 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 3 cm, watchful waiting seems not advisable.
- Published
- 2018