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2013 ; 37
(6
): 853-9
Nephropedia Template TP
gab.com Text
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English Wikipedia
Comparison of WHO Classifications (2004, 2010), the Hochwald grading system, and
AJCC and ENETS staging systems in predicting prognosis in locoregional
well-differentiated pancreatic neuroendocrine tumors
#MMPMID23598967
Liu TC
; Hamilton N
; Hawkins W
; Gao F
; Cao D
Am J Surg Pathol
2013[Jun]; 37
(6
): 853-9
PMID23598967
show ga
It is difficult to predict prognosis in patients with locoregional
well-differentiated (WD) pancreatic neuroendocrine tumors (PanNET). We aimed to
examine commonly used stratification systems [World Health organization (WHO)
2004 and 2010 classifications, American Joint Committee on Cancer (AJCC) and
European Neuroendocrine Tumor Society (ENETS) staging, and the Hochwald grading
system] for their power in predicting recurrence-free survival (RFS) in these
patients. Seventy-five such patients (mean age 56 y, mean follow-up 79 mo) who
underwent resection with sufficient tissue material and follow-up data were
studied. RFS was correlated with variable clinicopathologic features and
stratified with above-mentioned systems. Concordance index (CI) was then
calculated. With the WHO 2004 classification, 16, 35, and 24 PanNETs were
classified as benign behavior, uncertain behavior, and WD endocrine carcinoma,
respectively. By the WHO 2010 classification, 26, 41, and 8 tumors were grade 1,
2, and 3, respectively. Using the Hochwald system, 47 were low grade, and 28 were
intermediate grade. The AJCC staging information was complete for 62 patients (13
had the lymph node status Nx) and included: stages IA (19/62), IB (10/62), IIA
(10/62), and IIB (23/62). The ENETS staging information was stages I (16/62), IIa
(8/62), IIb (14/62), IIIa (0/62), and IIIb (24/62). The average Ki-67
proliferation index (PI) was 8.1%. Factors that predicted RFS included tumor
size, nodal metastasis, vascular invasion, perineural invasion, necrosis,
mitosis, and Ki-67 PI (all P<0.01). The CI for each system was: 0.6361 for WHO
2004, 0.6735 for WHO 2010, 0.6495 for AJCC staging, 0.6642 for ENETS staging, and
0.6851 for the Hochwald grading system. When these systems were analyzed in
conjunction with various additional important pathologic features, combination of
the Hochwald grading system and Ki-67 PI achieved the highest CI (0.7946).
Therefore, although all these systems predict RFS well in locoregional WD
PanNETs, the Hochwald grading system achieves the highest predictive ability.
Further predictive power can be achieved by combining the Hochwald grading system
and Ki-67 PI.