WHO 2010 and WHO 2000 Classification: From a Sensitive Analysis to Reality
Context In 2010 WHO released a new classification system for pancreatic endocrine tumors (PETs). Objectives To compare WHO-2010 with WHO-2000 classification in patients affected by PETs who underwent surgery. Methods Data regarding 67 patients were extracted from a dedicate database containing 92 patients undergone surgical exploration for pancreatic neuroendocrine tumors (pNETs). Patients without Ki-67 determination were excluded. Sex, age, presence of symptoms, hormonal status, site of tumor, presence of MEN1, surgical procedure, R status, TNM-ENETS stage, WHO 2000 and WHO 2010 classification, Ki-67, disease specific survival (DSS) with univariate and multivariate analyses. Results There were 36 (53.7%) females and 31 (46.3%) males. Mean age of patients was 57±13 years. Symptoms were present in 49 (73.1%) patients. Forty-nine (73.1%) patients had non-functioning pNETs and the tumour was located more frequently in the head (34.3%) and body (37.3%). Seven (10.4%) patients were affected by MEN1. R0 resection was carried out in 54 cases (80.6%) cases. Ki-67 was <2% in 30 (44.8%) patients, ranged 2-20% in 33 (49.3%) patients and was >20% in 4 (6.0%) patients. According WHO-2000, 33 (49.3%) patients had a well differentiated tumours (WDT), 26 (38.8%) had well differentiated carcinoma (WDCa), and 8 (11.9%) had poorly differentiated carcinoma (PDCa). According to WHO 2010, 30 (44.8%) pNETs G1, 33 (49.3%) pNETs G2 and 4 (6.0%) pancreatic neuroendocrine carcinomas (pNECs) G3. According TNM-ENETS stage there were 28 (41.8%), 4 (6.0%), 24 (35.8%) and 11 (16.4%) patients in stage I, II, III, and IV, respectively. Mean DSS was 263±17 months. Multivariate analysis found that WHO 2000 was the only independent factor related to DSS (HR=24; P=0.003). Conclusion WHO 2000 remains in our experience the best factor predicting DSS in patient affected by pNETs.
Copyright (c) 2014 Claudio Ricci, Francesco Monari, Salvatore Buscemi, Marielda D’Ambra, Davide Campana, Riccardo Panzacchi, Claudio Ceccarelli, Marcello Labombarda, Giovanni Taffurelli, Raffaele Pezzilli, Donatella Santini, Paola Tomassetti, riccardo casadei, Francesco Minni
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