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Will Ki-67 Predict Lymph Node Status in Pancreatic Endocrine Tumors?
Derick Christian*, Amit S. Khithani, a. Joe Saad, Joshua G. Barton, Jeffrey D. Linder, Prabhleen Chahal, Riteshkumar Patel, D. Rohan Jeyarajah
Methodist Dallas Medical Center, Dallas, TX
Background: Pancreatic endocrine tumors (PET) are rare and exhibit an uncertain biological behavior. Many studies have suggested that certain tumor markers and factors such as size and mitotic count may predict the behavior of PET. However the role of Ki-67 proliferative index is much debated.Aims and objectives: To evaluate the significance of tumor size and Ki-67 proliferative index with lymph node status in PET.Methods: Records of patients who underwent surgical resection for PET between September 2005 to September 2009 by a single surgeon were reviewed. Pathologic variables were tumor size, lymph node status and ki-67 proliferative index.Results:Of the 248 pancreatic resections performed at our Non University Tertiary care center (NUTCC), a total of 24 pancreatic resections were performed for PET. Of these, 18 (75%) underwent distal pancreatectomy and 6 (24%) underwent pancreatoduodenectomy. PET was limited to the pancreas or regional lymph nodes in 23 (96%) patients whereas 1 (4%) patient had distant metastatic disease. Multifocal disease within the pancreas was found in 8 (32%) patients, 9 (36%) had lymph node (LN) metastasis, vascular invasion was present in 8(33%), 23(96%) patients underwent R0 resection, and 17 (71%) patients had tumor larger than 2 cm. The distribution of patients as per Ki-67 proliferative index is shown in table 1. The patient with distant metastatic disease had a large tumor (5 cm) and a “high” Ki-67 proliferative index (38%).Conclusion:PET are recognized and diagnosed with greater frequency. Lymph node involvement in PET appears to be associated with larger tumor size. A high Ki-67proliferative index (>10%) predicts of lymph node metastasis in larger tumors (> 2 cms). Preoperative Ki-67 should be done to predict LN metastasis in PETs so as to evaluate the potential need for preoperative systemic therapy. Additional studies are needed to investigate the exact correlation between Ki-67 proliferative index, size and lymph node metastasis.
Table 1: Distribution of Ki-67 index as per size and LN status
| Ki-67 index <2% | Ki-67 index 2%- 10% | Ki-67 index >10% | |
| Size > 2 cms | 6 2 LN + (33%) | 6 1 LN + (16%) | 5 5 LN + (100%) |
| Size < 2 cms | 5 1 LN+ (20%) | 2 0 LN + | 0 |
| Total | 11 3 LN + (27%) | 8 1 LN + (13%) | 5 5 LN + (100%) |
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