A Lymph Node Ratio Model for Prognosis of Patients with Pancreatic Neuroendocrine Tumors

Esther Osher*, Eiman Shalabna, Joseph M. Klausner, Yona Greenman, Naftali Stern, Oren Shibolet, Erez Scapa, Oz Yakir, Dana Ben Ami Shor, Iddo Bar-Yishay, Sivan Shamai, Yael Sofer, Nir Lubezky, Yaacov Goykhman, Guy Lahat, Ido Wolf, Sharon Pelles, Asaf Aizic, Arye Blachar, Ravit Geva

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


The objective of this study was to determine the prognostic value of lymph node (LN) involvement and the LN ratio (LNR) and their effect on recurrence rates and survival in patients with pancreatic neuroendocrine tumors (PNETs) undergoing surgery. This single-center retrospective study reviewed the medical records of 95 consecutive patients diagnosed with PNETs who underwent surgery at our medical center between 1997 and 2017. The retrieved information included patient demographics, pathology reports, treatments, and oncological outcomes. Results: 95 consecutive potentially suitable patients were identified. The 78 patients with PNETs who underwent surgery and for whom there was adequate data were included in the analysis. Their mean ± standard deviation age at diagnosis was 57.4 ± 13.4 years (range 20–82), and there were 50 males (64%) and 28 females (36%). 23 patients (30%) had LN metastases (N1). The 2.5- and 5-year disease-free survival (DFS) rates for the entire cohort were 79.5% and 71.8%, respectively, and their 2- and 5-year overall survival (OS) rates were 85.9% and 82.1%, respectively. The optimal value of the LNR was 0.1603, which correlated with the outcome (2-year OS p = 0.002 HR = 13.4 and 5-year DFS p = 0.016 HR = 7.2, respectively, and 5-year OS and 5-year DFS p = 0.004 HR = 9 and p = 0.001 HR = 10.6, respectively). However, the multivariate analysis failed to show that the LNR was an independent prognostic factor in PNETs. Patients with PNETs grade and stage are known key prognostic factors influencing OS and DFS. According to our results, LNR failed to be an independent prognostic factor.

Original languageEnglish
Article number407
Issue number2
StatePublished - Feb 2023


  • ki-67
  • lymph node ratio
  • neuroendocrine tumor
  • pancreatic


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