Competitive Testing of the WHO 2010 versus the WHO 2017 Grading of Pancreatic Neuroendocrine Neoplasms: Data from a Large International Cohort Study

TY - JOUR

T1 - Competitive Testing of the WHO 2010 versus the WHO 2017 Grading of Pancreatic Neuroendocrine Neoplasms

T2 - Data from a Large International Cohort Study

AU - Rindi, Guido

AU - Klersy, Catherine

AU - Albarello, Luca

AU - Baudin, Eric

AU - Bianchi, Antonio

AU - Buchler, Markus W

AU - Caplin, Martyn

AU - Couvelard, Anne

AU - Cros, Jérôme

AU - de Herder, Wouter W

AU - Delle Fave, Gianfranco

AU - Doglioni, Claudio

AU - Federspiel, Birgitte

AU - Fischer, Lars

AU - Fusai, Giuseppe

AU - Gavazzi, Francesca

AU - Hansen, Carsten P

AU - Inzani, Frediano

AU - Jann, Henning

AU - Komminoth, Paul

AU - Knigge, Ulrich P

AU - Landoni, Luca

AU - La Rosa, Stefano

AU - Lawlor, Rita T

AU - Luong, Tu V

AU - Marinoni, Ilaria

AU - Panzuto, F

AU - Pape, Ulrich-Frank

AU - Partelli, Stefano

AU - Perren, Aurel

AU - Rinzivillo, Maria

AU - Rubini, Corrado

AU - Ruszniewski, Philippe

AU - Scarpa, Aldo

AU - Schmitt, Anja

AU - Schinzari, Giovanni

AU - Scoazec, Jean-Yves

AU - Sessa, Fausto

AU - Solcia, Enrico

AU - Spaggiari, Paola

AU - Toumpanakis, Christos

AU - Vanoli, Alessandro

AU - Wiedenmann, Bertram

AU - Zamboni, Giuseppe

AU - Zandee, Wouter T

AU - Zerbi, Alessandro

AU - Falconi, Massimo

N1 - © 2018 S. Karger AG, Basel.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND: The World Health Organization (WHO) and the American Joint Cancer Committee (AJCC) modified the grading of pancreatic neuroendocrine neoplasms from a three-tier (WHO-AJCC 2010) to a four-tier system by introducing the novel category of NET G3 (WHO-AJCC 2017).OBJECTIVES: This study aims at validating the WHO-AJCC 2017 and identifying the most effective grading system.METHOD: A total of 2,102 patients were enrolled; entry criteria were: (i) patient underwent surgery; (ii) at least 2 years of follow-up; (iii) observation time up to 2015. Data from 34 variables were collected; grading was assessed and compared for efficacy by statistical means including Kaplan-Meier method, Cox regression analysis, Harrell's C statistics, and Royston's explained variation in univariable and multivariable analyses.RESULTS: In descriptive analysis, the two grading systems demonstrated statistically significant differences for the major category sex but not for age groups. In Cox regression analysis, both grading systems showed statistically significant differences between grades for OS and EFS; however, no statistically significant difference was observed between the two G3 classes of WHO-AJCC 2017. In multivariable analysis for the two models fitted to compare efficacy, the two grading systems performed equally well with substantially similar optimal discrimination and well-explained variation for both OS and EFS. The WHO-AJCC 2017 grading system retained statistically significant difference between the two G3 classes for OS but not for EFS.CONCLUSIONS: The WHO-AJCC 2017 grading system is at least equally performing as the WHO-AJCC 2010 but allows the successful identification of the most aggressive PanNET subgroup. Grading is confirmed as probably the most powerful tool for predicting patient survival.

AB - BACKGROUND: The World Health Organization (WHO) and the American Joint Cancer Committee (AJCC) modified the grading of pancreatic neuroendocrine neoplasms from a three-tier (WHO-AJCC 2010) to a four-tier system by introducing the novel category of NET G3 (WHO-AJCC 2017).OBJECTIVES: This study aims at validating the WHO-AJCC 2017 and identifying the most effective grading system.METHOD: A total of 2,102 patients were enrolled; entry criteria were: (i) patient underwent surgery; (ii) at least 2 years of follow-up; (iii) observation time up to 2015. Data from 34 variables were collected; grading was assessed and compared for efficacy by statistical means including Kaplan-Meier method, Cox regression analysis, Harrell's C statistics, and Royston's explained variation in univariable and multivariable analyses.RESULTS: In descriptive analysis, the two grading systems demonstrated statistically significant differences for the major category sex but not for age groups. In Cox regression analysis, both grading systems showed statistically significant differences between grades for OS and EFS; however, no statistically significant difference was observed between the two G3 classes of WHO-AJCC 2017. In multivariable analysis for the two models fitted to compare efficacy, the two grading systems performed equally well with substantially similar optimal discrimination and well-explained variation for both OS and EFS. The WHO-AJCC 2017 grading system retained statistically significant difference between the two G3 classes for OS but not for EFS.CONCLUSIONS: The WHO-AJCC 2017 grading system is at least equally performing as the WHO-AJCC 2010 but allows the successful identification of the most aggressive PanNET subgroup. Grading is confirmed as probably the most powerful tool for predicting patient survival.

U2 - 10.1159/000494355

DO - 10.1159/000494355

M3 - Journal article

C2 - 30300897

SN - 0028-3835

VL - 107

SP - 375

EP - 386

JO - Neuroendocrinology

JF - Neuroendocrinology

IS - 4

ER -