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Accuracy of Grading in Pancreatic Neuroendocrine Neoplasms and Effect on Survival Estimates: An Institutional Experience

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Accurate grading of neuroendocrine neoplasms (NENs) is crucial for proper assessment of prognosis. Estimation of the proliferative indices, if not performed properly, is largely erroneous due to significant intratumoral heterogeneity. We sought to establish the degree of error in the grading of a cohort of curatively resected pancreatic NENs (PanNENs) and the theoretical impact of that in a larger cohort of Surveillance, Epidemiology, and End Results (SEER) patients.

Methods

A retrospective query of an institutional surgical database was performed from 2000 to 2018 to identify optimally resected PanNENs, which were reviewed by two gastrointestinal pathologists and regraded according to the WHO 2017 classification. Overall survival and recurrence-free survival were estimated using the Kaplan–Meier method for original and new grading systems, respectively and Cox proportional hazards models were used to evaluate the effect of the interested variables, including new grading systems.

Results

A total of 176 cases were identified. After regrading, 17/64 (26.6%) G1 neoplasms were classified as G2 and 12/95 (12.6%) G2 neoplasms were classified as G1, while 1/11 (9.1%) G3 neoplasms were classified as G2. Our expert gastrointestinal pathologists agreed on 97% of reclassified cases by blind review. Application of the G1/G2 misclassification errors on various groups, including PanNENs, in a SEER database of 1385 patients rendered the reported survival differences nonsignificant (1000 repetitions; p = 0.063, 95% confidence interval 0.056–0.070).

Conclusions

Mischaracterization of grade is common in optimally resected PanNENs but is eliminated with proper training and adherence to guidelines. The discrepancy rates can cast doubt on the generally accepted survival differences between G1 and G2 patients, as surmised by large database analyses.

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Acknowledgments

Preliminary data for this paper were presented in abstract form at the 2018 NANETS conference in Seattle, WA, USA.

Funding

GAW and JL were supported by SPORE grant 5P50CA196510-02. REDCap is supported by a Clinical and Translational Science Award (CTSA) grant (UL1 TR000448) and Siteman Comprehensive Cancer Center and National Cancer Institute Cancer Center support grant P30 CA091842.

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Author notes

  1. Nikolaos A. Trikalinos and Deyali Chatterjee have contributed equally to this study.

Authors and Affiliations

  1. Division of Oncology, Department of Medicine, Washington University in St. Louis, St Louis, MO, USA

    Nikolaos A. Trikalinos MD

  2. Department of Pathology and Immunology, Washington University in St. Louis, St Louis, MO, USA

    Deyali Chatterjee MD & Jane Lee MD

  3. Department of Surgery, Washington University in St. Louis, St Louis, MO, USA

    Jingxia Liu MS, PhD, Greg Williams MA, William Hawkins MD, FACS & Chet Hammill MD, MCR, FACS

Authors
  1. Nikolaos A. Trikalinos MD
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  2. Deyali Chatterjee MD
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  3. Jane Lee MD
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  4. Jingxia Liu MS, PhD
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  5. Greg Williams MA
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  6. William Hawkins MD, FACS
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  7. Chet Hammill MD, MCR, FACS
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Corresponding author

Correspondence to Nikolaos A. Trikalinos MD.

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Disclosures

Nikolaos A. Trikalinos, Deyali Chatterjee, Jane Lee, Jingxia Liu, Greg Williams, William Hawkins, and Chet Hammill declare no conflicts of interest.

Ethical Approval

This research was conducted ethically and in accordance with the World Medical Association Declaration of Helsinki. Approval for the study was obtained from the Washington University Institutional Review Board.

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Trikalinos, N.A., Chatterjee, D., Lee, J. et al. Accuracy of Grading in Pancreatic Neuroendocrine Neoplasms and Effect on Survival Estimates: An Institutional Experience. Ann Surg Oncol 27, 3542–3550 (2020). https://doi.org/10.1245/s10434-020-08377-x

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  • DOI: https://doi.org/10.1245/s10434-020-08377-x

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