Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026
Prognostic and recurrence implications of subdividing WHO grade 2 pancreatic neuroendocrine tumors at a 10% Ki-67 threshold.
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Choi Go-Won, Lee Inhyuck, Seo Younsoo, Han Youngmin, Chae Yoon Soo, Jung Hye-Sol, Cho Young Jae, Kwon Wooil, Jang Jin-Young, Park Joon Seong
Аннотация
BACKGROUND: Although World Health Organization (WHO) grade 1 and 2 pancreatic neuroendocrine tumors (pNETs) are generally regarded as indolent, substantial biological heterogeneity exists, particularly within grade 2 (G2) tumors. This study evaluated whether subdividing G2 pNETs using new Ki-67 threshold improves postoperative risk stratification following curative resection.
METHODS: We retrospectively analyzed consecutive adults who underwent pancreatectomy for pNETs between 2010 and 2022. Tumors were classified as G1 (<3%), G2a (3-<10%), G2b (10-<20%), and G3 (≥20%). Outcomes were disease-free survival (DFS) and overall survival (OS) assessed through December 31, 2024. Multivariable Cox models identified independent predictors of DFS and OS.
RESULTS: Among 300 patients (mean tumor size 2.65 ± 1.90 cm), grade distribution was 65.3%, 26.3%, 6.0%, and 2.3% for G1, G2a, G2b, and G3, respectively. DFS declined stepwise across grades (p < 0.001), with 5-year DFS of 88.1%, 68.9%, 45.5%, and 21.4%, respectively. OS also differed by grade (p < 0.001). On multivariable analysis, T stage >2, lymph node positivity, mitotic count >2, and grade subtype were independently associated with worse DFS, while grade subtype remained the only independent predictor of OS.
CONCLUSION: Subclassification of WHO G2 pNETs using a 10% Ki-67 threshold enhances postoperative risk stratification. When integrated with established pathological factors, this approach may better identify patients at increased risk of recurrence following curative resection.
METHODS: We retrospectively analyzed consecutive adults who underwent pancreatectomy for pNETs between 2010 and 2022. Tumors were classified as G1 (<3%), G2a (3-<10%), G2b (10-<20%), and G3 (≥20%). Outcomes were disease-free survival (DFS) and overall survival (OS) assessed through December 31, 2024. Multivariable Cox models identified independent predictors of DFS and OS.
RESULTS: Among 300 patients (mean tumor size 2.65 ± 1.90 cm), grade distribution was 65.3%, 26.3%, 6.0%, and 2.3% for G1, G2a, G2b, and G3, respectively. DFS declined stepwise across grades (p < 0.001), with 5-year DFS of 88.1%, 68.9%, 45.5%, and 21.4%, respectively. OS also differed by grade (p < 0.001). On multivariable analysis, T stage >2, lymph node positivity, mitotic count >2, and grade subtype were independently associated with worse DFS, while grade subtype remained the only independent predictor of OS.
CONCLUSION: Subclassification of WHO G2 pNETs using a 10% Ki-67 threshold enhances postoperative risk stratification. When integrated with established pathological factors, this approach may better identify patients at increased risk of recurrence following curative resection.