TY - JOUR
T1 - Comparison of benign and malignant insulinoma
AU - Sada, Alaa
AU - Yamashita, Thomas Szabo
AU - Glasgow, Amy E.
AU - Habermann, Elizabeth B.
AU - Thompson, Geoffrey B.
AU - Lyden, Melanie L.
AU - Dy, Benzon M.
AU - Halfdanarson, Thorvardur R.
AU - Vella, Adrian
AU - McKenzie, Travis J.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/2
Y1 - 2021/2
N2 - Background: How malignant insulinomas present relative to benign insulinomas is unknown. Methods: A single-institution retrospective study identified patients with insulinoma. Malignancy was defined by distant metastases, positive lymph node(s), T stage of 4, direct invasion into surrounding peripancreatic tissue, or presence of lymphovascular invasion. Wilcoxon Rank Sum tests and Kaplan-Meier analysis were used. Results: A total of 311 patients were identified: 51 malignant and 260 benign. Patients with malignant insulinoma presented with higher levels of insulin, proinsulin, and c-peptide. Malignant lesions were larger: 4.2 ± 3.2 vs 1.8 ± 0.8 cm in benign lesions, p < 0.01. Overall survival at 5 years was 66.8% vs 95.4% for malignant and benign insulinoma respectively, p < 0.01. Conclusions: Larger size of insulinoma and increased serum β-cell polypeptide concentrations were associated with malignancy. Malignant insulinoma has poorer survival. Further work-up to rule out malignancy may be indicated for larger pancreatic lesions and for patients with higher pre-operative insulin and pro-insulin.
AB - Background: How malignant insulinomas present relative to benign insulinomas is unknown. Methods: A single-institution retrospective study identified patients with insulinoma. Malignancy was defined by distant metastases, positive lymph node(s), T stage of 4, direct invasion into surrounding peripancreatic tissue, or presence of lymphovascular invasion. Wilcoxon Rank Sum tests and Kaplan-Meier analysis were used. Results: A total of 311 patients were identified: 51 malignant and 260 benign. Patients with malignant insulinoma presented with higher levels of insulin, proinsulin, and c-peptide. Malignant lesions were larger: 4.2 ± 3.2 vs 1.8 ± 0.8 cm in benign lesions, p < 0.01. Overall survival at 5 years was 66.8% vs 95.4% for malignant and benign insulinoma respectively, p < 0.01. Conclusions: Larger size of insulinoma and increased serum β-cell polypeptide concentrations were associated with malignancy. Malignant insulinoma has poorer survival. Further work-up to rule out malignancy may be indicated for larger pancreatic lesions and for patients with higher pre-operative insulin and pro-insulin.
KW - Insulinoma
KW - Pancreas
KW - Pancreatic neuroendocrine tumor
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U2 - 10.1016/j.amjsurg.2020.08.003
DO - 10.1016/j.amjsurg.2020.08.003
M3 - Article
C2 - 32873371
AN - SCOPUS:85089981899
SN - 0002-9610
VL - 221
SP - 437
EP - 447
JO - American journal of surgery
JF - American journal of surgery
IS - 2
ER -