Abstract:Objective To summarize our experience in diagnosis and surgical treatment of nonfunctioning pancreatic neuroendocrine carcinoma (NPNEC).
Methods The clinical data of 18 cases of NPNEC, including Group A those with liver metastasis, n=8; Group B those without liver metastasis, n=10, from 1985 to 2004 were retrospectively reviewed. Operations were performed in 16 cases, interventional procedures in 15 cases, and nonoperative treatment in 2 cases respectively. The markers of neuroendocrine cell (CgA, NSE, Syn) and the main peptide hormones (insulin, gastrin, glucagon, VIP, and somatostatin) were examined in tumor samples with immunohistochemistry method.
Results Group A and B were similar with respect to age (year) and tumor diameter (cm) at diagnosis (40.50±12.54 vs 51.60±12.85, and 8.45±5.12 vs 6.26±3.65, respectively; P>0.05). Positive expression of 2 or all 3 markers of neuroendocrine cell was detected in all 16 samples; negative expression of all 5 peptide hormones was observed in only 25% of samples. At a mean followup of 44.2 months (range 4 months-7 years ), the mean time from resection to relapse or metastasis was 29.8 months; 7 cases survived more than 5 years, of which 2 have survived for 7 years. Two cases, who subjected nonoperative treatment, survired 39,61 months, respectively.
Conclusions Clinical manifestations of NPNEC are nonspecific. Only a few tumors in NPNEC patients do not yield peptide hormones. Treatment of NPNEC (including patients with liver metastasis) with aggressive surgical resection followed by interventional methods can result in excellent overall longterm survival.