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Table 2 Clinical features of p-NENs in the present study according to the WHO 2017 and 2010 grading classification

From: World Health Organization grading classification for pancreatic neuroendocrine neoplasms: a comprehensive analysis from a large Chinese institution

Factor WHO 2017/2010 criteriaA WHO 2017 criteriaA WHO 2010 criteriaA  
NET G1
(N = 150)
NET G2
(N = 158)
NET G3
(N = 64)
NEC G3
(N = 108)
“NEC G3”
(N = 172)
All
(N = 480)
Gender
 Female 88 (58.7%) 97 (61.4%) 38 (59.4%) 62 (57.5%) 100 (58.1%) 285 (59.4%)
Age, yrs.
 Mean ± SD 45.7 ± 15. 49.1 ± 8.5 50.2 ± 7.8 54.1 ± 9.2 52.7 ± 10. 49.5 ± 8.6
 Median 2 48 52 57 253 50
 Range 45 7–68 12–82 7–71 14–80 7–80 7–82
 Tumor size, cm. 2.9 ± 2.1 5.5 ± 2.8 5.6 ± 3.5 5.9 ± 4.1 5.1 ± 3.9 5.6 ± 4.8
 Mean ± SD 2.0 4.0 4.5 5.6 5.1 4.0
 Median Range 0.3–7.2 1.2–14.5 1.8–7.6 1.6–13.1 1.6–13.1 0.3–14.5
Functional status
 Non-functional 62 (41.3%) 88 (55.7%) 44 (68.7%) 72 (66.7%) 116 (67.4%) 266 (55.4%)
 FunctionalB 88 (58.7%) 70 (44.3%) 20 (31.3%) 36 (33.3%) 56 (32.6%) 214 (44.6%)
 Incidental diagnosis 35 (23.3%) 46 (29.1%) 14 (21.9%) 25 (23.1%) 39 (22.7%) 120 (25.0%)
 Diagnosis after 2010 98 (65.3%) 108 (68.4%) 54 (84.4%) 89 (82.4%) 143 (83.1%) 349 (72.7%)
 Tumor location
 Body/tail 85 (56.7%) 100 (63.3%) 43 (67.2%) 68 (62.9%) 111 (64.5%) 296 (61.7%)
Surgical margin
 ″R0C 126 (84.0%) 124 (78.5%) 33 (82.5%) 46 (70.7%) 89 (84.8%) 339 (70.6%)
 Postoperative medical therapyD 31 (20.7%) 41 (25.9%) 29 (45.3%) 61 (56.5%) 90 (52.3%) 162 (33.8%)
 Vascular infiltration 16 (10.7%) 32 (20.3%) 16 (25.0%) 35 (32.4%) 51 (29.7%) 99 (45.3%)
 Lymph involvement 35 (23.3%) 52 (32.9%) 22 (34.4%) 50 (46.3%) 72 (41.9%) 159 (33.1%)
 Distant metastasisE 20 (13.3%) 30 (19.0%) 12 (18.7%) 32 (29.6%) 44 (25.6%) 94 (19.6%)
 Hepatic 12 (8.0%) 15 (9.5%) 6 (9.4%) 20 (18.5%) 26 (15.1%) 51 (10.6%)
 Bone 5 (3.3%) 8 (5.1%) 3 (4.7%) 10 (9.3%) 13 (7.5%) 26 (5.4%)
 Lymph nodal 10 (6.6%) 14 (8.9%) 4 (6.3%) 16 (14.8%) 20 (11.6%) 44 (9.2%)
 Out of contact 30 (20.0%) 38 (24.1%) 9 (14.1%) 23 (21.3%) 32 (18.6%) 100 (20.4%)
 Dead at follow-up 44 (36.7%) 48 (40.0%) 28 (50.9%) 56 (69.1%) 84 (60.0%) 176 (46.3%)
 5-year OS 75.8% 58.4% 35.1% 11.1% 21.2% 53.0%
 MST, mons. 85.3 67.4 51.3 26.8 34.5 63.1
TNM staging system by AJCC 2017 8th staging manualF
Stage I
Stage II
Stage III
Stage IV
WHO 2017 NET G1/G2/G3G (N = 372) WHO 2017 NEC G3G (N = 108)
Cases(%) Out of contact Dead at follow-up 5-year OS Cases(%) Out of contact Dead at follow-up 3-year OS
116 (31.2%)
108 (29.1%)
86 (23.1%)
62 (16.6%)
16 (13.8%)
20 (18.5%)
20 (23.6%)
20 (32.3%)
19 (19.0%)
23 (26.1%)
41 (62.1%)
37 (88.1%)
89.2%
70.5%
51.2%
18.9%
18 (16.7%)
30 (27.8%)
28 (25.9%)
32 (29.6%)
6 (33.7%)
10 (33.3%)
2 (7.1%)
6 (18.8%)
6 (50.0%)
13 (65.0%)
19 (73.1%)
18 (69.2%)
80.8%
33.2%
7.1%
NA
  1. A: The NET G1 and NET G2 were consistently defined in WHO 2017 and 2010 grading criteria for p-NENs, while the “NEC G3” of WHO 2010 criteria was composed of both NET G3 and NEC G3 of WHO 2017 criteria [8, 14]
  2. B: Referring to insulinoma, gastrinoma, vasoactive intestinal polypeptidoma, adrenocorticotropic hormone adenoma, glucagonoma, pheochromocytoma, etc.
  3. C: Referring to radical resections with both grossly and microscopically negative surgical margins
  4. D: Referring to conventional chemotherapy and novel molecular targeted therapies
  5. E: Distant metastases (hepatic, bone, lymph nodal) for patients with p-NENs was present at diagnosis
  6. F: In the AJCC 2017 staging manual, one TNM system was originally proposed for G1/G2 p-NETs, the other for “G3 p-NECs” of WHO 2010 criteria
  7. G: The G3 p-NETs of WHO 2017 grading classification were also staged by the system for G1/G2 p-NETs, while the G3 p-NECs of WHO 2017 criteria were staged by the system for pancreatic exocrine adenocarcinomas, as we have demonstrated in the previous report [19]
  8. Abbreviations: p-NENs Pancreatic neuroendocrine neoplasms; WHO World Health Organization; NET Neuroendocrine tumors; NEC Neuroendocrine carcinoma; G Grading; TNM Tumor-node-metastasis; AJCC American Joint Committee On Cancer; NA Not applicable; OS Overall survival; MST Median survival time