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Surgical Resection Is the Only Effective Therapy for Primary and Metastatic Pancreatic Islet Cell Carcinoma
Shaun Mckenzie*1, Avo Artinyan2, Brian Mailey1, Alessio Pigazzi1, Joshua Ellenhorn1, Joseph Kim1
1General and Oncologic Surgery, City of Hope, Duarte, CA; 2Surgery, Baylor College of Medicine, Houston, TX
Background: Multidisciplinary management of patients with pancreatic islet cell carcinoma (ICC) remains poorly defined. Our objective was to determine the role of multidisciplinary therapy of pancreatic ICC. Methods: The Los Angeles County Cancer Surveillance Program (CSP) was queried to identify all patients diagnosed with ICC during the study period of 1982-2006. Patients receiving pancreatic resection, chemotherapy (CT), radiation therapy (RT) either alone or in combination were tabulated. Clinicopathologic characteristics and survival were compared. Multivariate Cox-regression analysis was performed to identify predictors of survival. Results: Two hundred thirty-six patients were diagnosed with ICC during the study period. The majority of patients (75%) initially presented with regional (n=82) or distant (n=95) disease. Treatment of the cohort consisted of pancreatic resection (n=82, 35%), chemotherapy (n=51, 21%) or radiation therapy (n=9, 4%). Select patients (n=14, 17%) underwent multimodal adjuvant therapy. Median survival (MS) for the entire cohort was 3.2 years. Stratified by therapy, surgical resection was associated with highest survival (MS 11.9 years; 71%, 5-year). Surgical resection was associated with improved survival when compared to medical management (chemotherapy and/or radiation therapy) for local, regional and distant disease (17.3 vs. 5.8 years, p= 0.002; 12.1 vs. 1.8 years, p=0.002; and 4.0 vs. 1.8 years, p=0.01; respectively). By multivariate analysis, surgical resection independently predicted improved survival (HR 0.35, CI 0.19-0.66, p=0.01). In contrast, chemotherapy and radiation were not associated with improved survival. Conclusion: In this largest series evaluating the multidisciplinary management of pancreatic ICC, surgical resection remains the only treatment modality associated with improved survival. Chemotherapy or radiotherapy as primary therapy or as an adjunct to surgery did not provide a survival benefit in these patients.
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