• Alessandra Pulvirenti, Ammar A Javed, Luca Landoni, Nigel B Jamieson, Joanne F Chou, Marco Miotto, Jin He, Mithat Gonen, Antonio Pea, Laura H Tang, Chiara Nessi, Sara Cingarlini, Michael I D'Angelica, Anthony J Gill, T Peter Kingham, Aldo Scarpa, Matthew J Weiss, Vinod P Balachandran, Jaswinder S Samra, John L Cameron, William R Jarnagin, Roberto Salvia, Christopher L Wolfgang, Peter J Allen, and Claudio Bassiy.
• Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
• Ann. Surg. 2021 Dec 1; 274 (6): 105110571051-1057.

ObjectiveTo develop a nomogram estimating the probability of recurrence free at 5 years after resection for localized grade 1 (G1)/ grade 2 (G2) pancreatic neuroendocrine tumors (PanNETs).BackgroundAmong patients undergoing resection of PanNETs, approximately 17% experience recurrence. It is not established which patients are at risk, with no consensus on optimal follow-up.MethodA multi-institutional database of patients with G1/G2 PanNETs treated at 2 institutions was used to develop a nomogram estimating the rate of freedom from recurrence at 5 years after curative resection. A second cohort of patients from 3 additional institutions was used to validate the nomogram. Prognostic factors were assessed by univariate analysis using Cox regression model. The nomogram was internally validated using bootstrap resampling method and on the external cohort. Performance was assessed by concordance index (c-index) and a calibration curve.ResultsThe nomogram was constructed using a cohort of 632 patients. Overall, 68% of PanNETs were G1, the median follow-up was 51 months, and we observed 74 recurrences. Variables included in the nomogram were the number of positive nodes, tumor diameter, Ki-67, and vascular/perineural invasion. The model bias-corrected c-index from the internal validation was 0.85, which was higher than European Neuroendocrine Tumors Society/ American Joint Committee on Cancer 8th staging scheme (c-index 0.76, P = <0.001). On the external cohort of 328 patients, the nomogram c-index was 0.84 (95% confidence interval 0.79-0.88).ConclusionOur externally validated nomogram predicts the probability of recurrence-free survival at 5 years after PanNETs curative resection, with improved accuracy over current staging systems. Estimating individual recurrence risk will guide the development of personalized surveillance programs after surgery.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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