@article{4413b103f693432f803683b70a23152d,
title = "Competitive testing of the WHO 2010 versus the WHO 2017 grading of pancreatic neuroendocrine neoplasms: Data from a large international cohort study",
abstract = "Background: The World Health Organization (WHO) and the American Joint Cancer Committee (AJCC) modified the grading of pancreatic neuroendocrine neoplasms from a three-tier (WHO-AJCC 2010) to a four-tier system by introducing the novel category of NET G3 (WHO-AJCC 2017). Objectives: This study aims at validating the WHO-AJCC 2017 and identifying the most effective grading system. Method: A total of 2,102 patients were enrolled; entry criteria were: (i) patient underwent surgery; (ii) at least 2 years of follow-up; (iii) observation time up to 2015. Data from 34 variables were collected; grading was assessed and compared for efficacy by statistical means including Kaplan-Meier method, Cox regression analysis, Harrell's C statistics, and Royston's explained variation in univariable and multivariable analyses. Results: In descriptive analysis, the two grading systems demonstrated statistically significant differences for the major category sex but not for age groups. In Cox regression analysis, both grading systems showed statistically significant differences between grades for OS and EFS; however, no statistically significant difference was observed between the two G3 classes of WHO-AJCC 2017. In multivariable analysis for the two models fitted to compare efficacy, the two grading systems performed equally well with substantially similar optimal discrimination and well-explained variation for both OS and EFS. The WHO-AJCC 2017 grading system retained statistically significant difference between the two G3 classes for OS but not for EFS. Conclusions: The WHO-AJCC 2017 grading system is at least equally performing as the WHO-AJCC 2010 but allows the successful identification of the most aggressive PanNET subgroup. Grading is confirmed as probably the most powerful tool for predicting patient survival.",
keywords = "Cellular and Molecular Neuroscience, Endocrine and Autonomic Systems, Endocrinology, Endocrinology, Diabetes and Metabolism, Grading, Neuroendocrine neoplasm, Pancreas, Personalized medicine, Staging, Tailored therapy, WHO, Cellular and Molecular Neuroscience, Endocrine and Autonomic Systems, Endocrinology, Endocrinology, Diabetes and Metabolism, Grading, Neuroendocrine neoplasm, Pancreas, Personalized medicine, Staging, Tailored therapy, WHO",
author = "Guido Rindi and Catherine Klersy and Luca Albarello and Eric Baudin and Antonio Bianchi and Buchler, {Markus W.} and Martyn Caplin and Anne Couvelard and J{\'e}r{\^o}me Cros and {De Herder}, {Wouter W.} and {Delle Fave}, Gianfranco and Claudio Doglioni and Birgitte Federspiel and Lars Fischer and Giuseppe Fusai and Francesca Gavazzi and Hansen, {Carsten P.} and Frediano Inzani and Henning Jann and Paul Komminoth and Knigge, {Ulrich P.} and Luca Landoni and {La Rosa}, Stefano and Lawlor, {Rita T.} and Luong, {Tu V.} and Ilaria Marinoni and F. Panzuto and Ulrich-Frank Pape and Stefano Partelli and Aurel Perren and Maria Rinzivillo and Corrado Rubini and Philippe Ruszniewski and Aldo Scarpa and Anja Schmitt and Giovanni Schinzari and Jean-Yves Scoazec and Fausto Sessa and Enrico Solcia and Paola Spaggiari and Christos Toumpanakis and Alessandro Vanoli and Bertram Wiedenmann and Giuseppe Zamboni and Zandee, {Wouter T.} and Alessandro Zerbi and Massimo Falconi",
year = "2018",
doi = "10.1159/000494355",
language = "English",
volume = "107",
pages = "375--386",
journal = "Neuroendocrinology",
issn = "0028-3835",
publisher = "S Karger AG:Allschwilerstrasse 10, CH-4009 Basel Switzerland:011 41 61 3061111, EMAIL: orders@karger.ch, INTERNET: http://www.karger.com, Fax: 011 41 61 3061234",
}