Revista ABCd (São Paulo). 05 Sep, 2026

Size alone is not enough: Ki-67 and invasion patterns identify high-risk pancreatic neuroendocrine tumors

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Background:

Pancreatic neuroendocrine tumors (pNETS) constitute a heterogeneous and rare disease worldwide. Diagnosis rates have been increasing, and the evaluation of prognostic factors has become even more important in the treatment decision-making process.

Aims:

To present results and prognostic factors in patients undergoing surgical treatment for pNETS at a single Brazilian center.

Results:

The most frequently performed surgical procedure was PCC+S 60.0%. The median hospital stay was 8 (5-13) days, and postoperative mortality occurred in 1.7%. Overall survival in 3 and 5 years was 93.8 and 92.1%, respectively. Disease-free survival at 3 and 5 years was 87.1 and 71.8%, respectively. Patients with tumors smaller than 2.0 cm did not present with lymph node disease or recurrence, and patients with tumors measuring 2.1-2.5cm had lymph node disease in 11.1% and recurrence in 11.1%. In univariate and multivariate analysis, the presence of lymphatic and perineural invasion and Ki67 (3-20) were strongly correlated with positive lymph node disease and recurrence, respectively.

Conclusions:

The presence of lymphatic and perineural invasion, Ki67 (3 to 20), and tumors larger than 2.5 cm correlated with positive lymph node disease and recurrence.


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