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Barbro Eriksson - One of the best experts on this subject based on the ideXlab platform.
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prognostic factors and survival in 324 patients with pancreatic Endocrine Tumor treated at a single institution
Clinical Cancer Research, 2008Co-Authors: Sara Ekeblad, Kristina Dunder, Britt Skogseid, Kjell Öberg, Barbro ErikssonAbstract:Purpose: Unequivocal pathologic markers for the prognosis of pancreatic Endocrine Tumors are often lacking. Suggestions for prognostic guidance include the WHO classification. Recently, a Tumor-node-metastasis (TNM) staging system was proposed. We evaluate this system, as well as assess other potential prognostic factors such as Tumor Ki67, size, Endocrine syndrome, heredity, body mass index (BMI), and plasma chromogranin A, in a large patient material treated at a single institution. Experimental Design: A total of 324 patients with pancreatic Endocrine Tumor, consecutively diagnosed and treated at a tertiary referral center, were retrospectively evaluated. Median follow-up was 54 months (range, 1-423 months). Patient and Tumor data were extracted from medical records. Univariate and multivariate analyses were done to recognize factors of prognostic value. Results: The median overall survival was 99 months (95% confidence interval, 81-117). Five- and 10-year survival rates were 64% and 44%, respectively. In univariate analysis, TNM stage, radical surgery, WHO classification, nonfunctioning Tumor, Ki67 ≥2%, chromogranin A ≥3 times the upper normal limit, BMI 2 , sporadic Tumor, Tumor size, and referral from our primary uptake area had a significant prognostic effect. In multivariate analysis, TNM stage, WHO classification, radical surgery, and Ki67 ≥2% retained their significance. Having a nonfunctioning Tumor was not an independent marker of poor prognosis and neither was heredity. Conclusions: The recently suggested TNM staging system emerged as a useful clinical tool.
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prognostic factors and survival in 324 patients with pancreatic Endocrine Tumor treated at a single institution
Clinical Cancer Research, 2008Co-Authors: Sara Ekeblad, Kristina Dunder, Britt Skogseid, Kjell Öberg, Barbro ErikssonAbstract:PURPOSE: Unequivocal pathologic markers for the prognosis of pancreatic Endocrine Tumors are often lacking. Suggestions for prognostic guidance include the WHO classification. Recently, a Tumor-node-metastasis (TNM) staging system was proposed. We evaluate this system, as well as assess other potential prognostic factors such as Tumor Ki67, size, Endocrine syndrome, heredity, body mass index (BMI), and plasma chromogranin A, in a large patient material treated at a single institution. EXPERIMENTAL DESIGN: A total of 324 patients with pancreatic Endocrine Tumor, consecutively diagnosed and treated at a tertiary referral center, were retrospectively evaluated. Median follow-up was 54 months (range, 1-423 months). Patient and Tumor data were extracted from medical records. Univariate and multivariate analyses were done to recognize factors of prognostic value. RESULTS: The median overall survival was 99 months (95% confidence interval, 81-117). Five- and 10-year survival rates were 64% and 44%, respectively. In univariate analysis, TNM stage, radical surgery, WHO classification, nonfunctioning Tumor, Ki67 > or = 2%, chromogranin A > or = 3 times the upper normal limit, BMI or = 2% retained their significance. Having a nonfunctioning Tumor was not an independent marker of poor prognosis and neither was heredity. CONCLUSIONS: The recently suggested TNM staging system emerged as a useful clinical tool.
Jerry D. Gardner - One of the best experts on this subject based on the ideXlab platform.
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multiple hormone elevations in zollinger ellison syndrome prospective study of clinical significance and of the development of a second symptomatic pancreatic Endocrine Tumor syndrome
Gastroenterology, 1990Co-Authors: H Victor C Chiang, Shihche Huang, Jerry D. Gardner, Thomas M Odorisio, Paul N MatonAbstract:Abstract In the present study of 45 patients with Zollinger-Ellison syndrome, the frequency and clinical importance of the release of multiple gastrointestinal peptides were assessed prospectively. During an initial evaluation, extent of gastrinoma, clinical symptoms, disease duration, and presence or absence of multiple Endocrine neoplasia, type I (MEN-I) were assessed. All patients had determinations of fasting plasma gastrin, human pancreatic polypeptide, motilin, neurotensin, and somatostatin; 35 had determinations of insulin and gastrin-releasing peptide and 21 had determinations of glucagon. A plasma elevation of additional peptides besides gastrin was detected in 62%, with 44% having one, 18% having two, and 0% having three additional peptides elevated. Motilin was elevated in 29%, human pancreatic polypeptide in 27%, neurotensin in 20%, and gastrin-releasing peptide in 10%, whereas insulin, glucagon, and somatostatin were not elevated in any patient. The presence or absence of elevation of any peptide did not differ in patients with or without MEN-I, with gastrinoma size, with the presence or absence of metastatic disease, or with various clinical symptoms. Patients were assessed yearly for clinical evidence of a secondary symptomatic pancreatic Endocrine Tumor syndrome with a median follow-up of 146 and 84 months from onset or diagnosis, respectively. Only one patient (2% of patients) developed a second syndrome (rate, 2 patients per 100 patients observed for 10 years). These results demonstrate that the plasma elevation of multiple gastrointestinal peptides is common in patients with Zollinger-Ellison syndrome; however, the rate of developing a second symptomatic pancreatic Endocrine Tumor syndrome is much lower than generally believed. Furthermore, no evidence is found to support the conclusions that the detection of the plasma elevation of these peptides is clinically important in assessing MEN-I status, disease extent, or presence of metastatic disease or that elevated levels of motilin, neurotensin, gastrin-releasing peptide, or human pancreatic peptide are associated with any distinct clinical symptoms. Therefore, we recommend that plasma concentrations of these additional gastrointestinal peptides should not be assessed routinely but rather only if new symptoms develop.
Asif Khalid - One of the best experts on this subject based on the ideXlab platform.
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pancreatic Endocrine Tumor eus guided fna dna microsatellite loss and mortality
Gastrointestinal Endoscopy, 2009Co-Authors: Kenneth E Fasanella, Kevin Mcgrath, Michael K Sanders, Debra Brody, Robyn T Domsic, Asif KhalidAbstract:Background The clinical course of pancreatic Endocrine Tumors (PET) depends on Tumor size, the presence of invasion or metastasis, the Ki-67 index, mitoses per high power field, and mutational damage. Most of this information is not available before surgery for clinical decision making or prognostication. Objective To evaluate PET EUS-guided FNA (EUS-FNA) microsatellite loss analysis in the context of PET-related mortality. Design A single institution retrospective cohort. Patients Patients with PET diagnosed by EUS-FNA who underwent DNA microsatellite loss analysis and at least 1 year of follow-up or subsequent death. Intervention PET microsatellite loss analysis results and current clinical status were compared. Results Twenty-nine patients were included in the final analysis; the mean age of the patients was 57 years, and 10 were women (35%). The mean follow-up was 33.7 months (median 30 months, range 2-66 months). Twelve patients had disease progression, and 8 died, all from disease-specific causes. Malignant PET contained multiple microsatellite losses, with a median fractional allelic loss (FAL) of 0.37 (range 0.12-0.69, interquartile range [IQR] 0.23-0.42), significantly different from benign PET, median FAL 0 (range 0-0.18, IQR 0-0.08, P P 0.2 ( P 0.2 and disease status or mortality. Limitations Retrospective design, referral bias, and DNA analysis availability. Conclusions PET EUS-FNA microsatellite loss analysis provides preoperative prognostic information. An FAL >0.2 is not only associated with disease progression but also with mortality.
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endoscopic ultrasound guided fine needle aspirate microsatellite loss analysis and pancreatic Endocrine Tumor outcome
Clinical Gastroenterology and Hepatology, 2006Co-Authors: Laurentia Nodit, Kevin Mcgrath, Maliha Zahid, Niraj Jani, Karen E Schoedel, Paul N Ohori, Sally E Carty, Sydney D Finkelstein, Asif KhalidAbstract:Background & Aims: The clinical course of pancreatic Endocrine Tumor (PET) varies depending on Tumor aggressiveness, disease extent, and possibly accumulated molecular alterations. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) results, although accurate in diagnosing PET, correlate poorly with PET outcome. The role of detecting key molecular abnormalities in predicting PET behavior and clinical outcome from EUS-FNA material remains unknown. Methods: Patients with confirmed PET who underwent EUS-FNA during a 32-month period were included. Patient demographics and clinical data were recorded and follow-up information was obtained by contacting their physician to evaluate disease progression. Representative Tumor cells were microdissected from the FNA material. DNA was harvested and amplified, targeting a panel of 17 polymorphic microsatellite markers on chromosomes 1p, 3p, 5q, 9p, 10q, 11q, 17p, 17q, 21q, and 22q. The polymerase chain reaction products were subjected to fluorescent capillary gel electrophoresis to detect microsatellite loss. The fractional allelic loss (FAL) was calculated. Results: Twenty-five patients were studied. Thirteen were classified histologically as benign PET limited to the pancreas and 12 as malignant PET (invasive or metastatic). The mean FAL in the benign and malignant PET was 0.03 and 0.37 ( P P Conclusions: Microsatellite loss analysis of EUS-FNA material from PET can be performed reliably and an FAL value of more than 0.2 is associated with disease progression. This technique may have value in the preoperative assessment and risk stratification of patients with PET.
Sara Ekeblad - One of the best experts on this subject based on the ideXlab platform.
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prognostic factors and survival in 324 patients with pancreatic Endocrine Tumor treated at a single institution
Clinical Cancer Research, 2008Co-Authors: Sara Ekeblad, Kristina Dunder, Britt Skogseid, Kjell Öberg, Barbro ErikssonAbstract:Purpose: Unequivocal pathologic markers for the prognosis of pancreatic Endocrine Tumors are often lacking. Suggestions for prognostic guidance include the WHO classification. Recently, a Tumor-node-metastasis (TNM) staging system was proposed. We evaluate this system, as well as assess other potential prognostic factors such as Tumor Ki67, size, Endocrine syndrome, heredity, body mass index (BMI), and plasma chromogranin A, in a large patient material treated at a single institution. Experimental Design: A total of 324 patients with pancreatic Endocrine Tumor, consecutively diagnosed and treated at a tertiary referral center, were retrospectively evaluated. Median follow-up was 54 months (range, 1-423 months). Patient and Tumor data were extracted from medical records. Univariate and multivariate analyses were done to recognize factors of prognostic value. Results: The median overall survival was 99 months (95% confidence interval, 81-117). Five- and 10-year survival rates were 64% and 44%, respectively. In univariate analysis, TNM stage, radical surgery, WHO classification, nonfunctioning Tumor, Ki67 ≥2%, chromogranin A ≥3 times the upper normal limit, BMI 2 , sporadic Tumor, Tumor size, and referral from our primary uptake area had a significant prognostic effect. In multivariate analysis, TNM stage, WHO classification, radical surgery, and Ki67 ≥2% retained their significance. Having a nonfunctioning Tumor was not an independent marker of poor prognosis and neither was heredity. Conclusions: The recently suggested TNM staging system emerged as a useful clinical tool.
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prognostic factors and survival in 324 patients with pancreatic Endocrine Tumor treated at a single institution
Clinical Cancer Research, 2008Co-Authors: Sara Ekeblad, Kristina Dunder, Britt Skogseid, Kjell Öberg, Barbro ErikssonAbstract:PURPOSE: Unequivocal pathologic markers for the prognosis of pancreatic Endocrine Tumors are often lacking. Suggestions for prognostic guidance include the WHO classification. Recently, a Tumor-node-metastasis (TNM) staging system was proposed. We evaluate this system, as well as assess other potential prognostic factors such as Tumor Ki67, size, Endocrine syndrome, heredity, body mass index (BMI), and plasma chromogranin A, in a large patient material treated at a single institution. EXPERIMENTAL DESIGN: A total of 324 patients with pancreatic Endocrine Tumor, consecutively diagnosed and treated at a tertiary referral center, were retrospectively evaluated. Median follow-up was 54 months (range, 1-423 months). Patient and Tumor data were extracted from medical records. Univariate and multivariate analyses were done to recognize factors of prognostic value. RESULTS: The median overall survival was 99 months (95% confidence interval, 81-117). Five- and 10-year survival rates were 64% and 44%, respectively. In univariate analysis, TNM stage, radical surgery, WHO classification, nonfunctioning Tumor, Ki67 > or = 2%, chromogranin A > or = 3 times the upper normal limit, BMI or = 2% retained their significance. Having a nonfunctioning Tumor was not an independent marker of poor prognosis and neither was heredity. CONCLUSIONS: The recently suggested TNM staging system emerged as a useful clinical tool.
H Victor C Chiang - One of the best experts on this subject based on the ideXlab platform.
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multiple hormone elevations in zollinger ellison syndrome prospective study of clinical significance and of the development of a second symptomatic pancreatic Endocrine Tumor syndrome
Gastroenterology, 1990Co-Authors: H Victor C Chiang, Shihche Huang, Jerry D. Gardner, Thomas M Odorisio, Paul N MatonAbstract:Abstract In the present study of 45 patients with Zollinger-Ellison syndrome, the frequency and clinical importance of the release of multiple gastrointestinal peptides were assessed prospectively. During an initial evaluation, extent of gastrinoma, clinical symptoms, disease duration, and presence or absence of multiple Endocrine neoplasia, type I (MEN-I) were assessed. All patients had determinations of fasting plasma gastrin, human pancreatic polypeptide, motilin, neurotensin, and somatostatin; 35 had determinations of insulin and gastrin-releasing peptide and 21 had determinations of glucagon. A plasma elevation of additional peptides besides gastrin was detected in 62%, with 44% having one, 18% having two, and 0% having three additional peptides elevated. Motilin was elevated in 29%, human pancreatic polypeptide in 27%, neurotensin in 20%, and gastrin-releasing peptide in 10%, whereas insulin, glucagon, and somatostatin were not elevated in any patient. The presence or absence of elevation of any peptide did not differ in patients with or without MEN-I, with gastrinoma size, with the presence or absence of metastatic disease, or with various clinical symptoms. Patients were assessed yearly for clinical evidence of a secondary symptomatic pancreatic Endocrine Tumor syndrome with a median follow-up of 146 and 84 months from onset or diagnosis, respectively. Only one patient (2% of patients) developed a second syndrome (rate, 2 patients per 100 patients observed for 10 years). These results demonstrate that the plasma elevation of multiple gastrointestinal peptides is common in patients with Zollinger-Ellison syndrome; however, the rate of developing a second symptomatic pancreatic Endocrine Tumor syndrome is much lower than generally believed. Furthermore, no evidence is found to support the conclusions that the detection of the plasma elevation of these peptides is clinically important in assessing MEN-I status, disease extent, or presence of metastatic disease or that elevated levels of motilin, neurotensin, gastrin-releasing peptide, or human pancreatic peptide are associated with any distinct clinical symptoms. Therefore, we recommend that plasma concentrations of these additional gastrointestinal peptides should not be assessed routinely but rather only if new symptoms develop.