# Impact of surgical approaches on long-term survival outcomes of patients with pancreatic neuroendocrine carcinoma

## TL;DR

This study compares two surgical approaches for pancreatic neuroendocrine carcinoma and finds similar long-term survival outcomes between them.

## Contribution

The study provides evidence that local resection is as effective as radical resection for PNEC without distant metastasis.

## Key findings

- Local resection and radical resection showed similar overall and cancer-specific survival in PNEC patients.
- Age, AJCC stage, N stage, and chemotherapy were independent prognostic factors for overall survival.
- AJCC stage and N stage were key predictors of cancer-specific survival.

## Abstract

Surgery is the primary treatment for pancreatic neuroendocrine carcinoma (PNEC), however, the optimal surgical approach remains undetermined. We aimed to compare long-term survival outcomes between patients who received local resection (LR) and radical resection (RR) for PNEC without distant metastasis. Patients diagnosed with PNEC between 2000 and 2020 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Selection bias was minimized by using propensity score matching (PSM). The Kaplan-Meier method and multivariate Cox proportional hazards models were utilized to evaluate overall survival (OS) and cancer-specific survival (CSS). A total of 1331 patients were enrolled in the study, with 678 receiving LR and 653 undergoing RR. The RR group exhibited a poorer grade, larger tumor size, and TN stage compared to the LR group (P <  0.05). After PSM, 450 matched pairs of patients were compared, with no significant differences in demographic and clinical characteristics observed. No significant differences were observed in long-term OS (P =  0.746) or CSS (P =  0.634) between the two groups. Subgroup analyses also demonstrated comparable OS and CSS between the LR and RR groups (P >  0.05). Multivariate Cox analysis revealed age, AJCC stage, N stage, and chemotherapy as independent prognostic risk factors for OS, while AJCC stage and N stage were identified as independent prognostic risk factors for CSS. Our study demonstrated that in patients with PNEC without distant metastasis, LR and RR exhibit similar prognoses, suggesting that LR may be adequate as a treatment option for these patients.