| 1. |
- Botling, Johan, et al.
(författare)
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High-grade progression confers poor survival in pancreatic neuroendocrine tumors
- 2020
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Ingår i: Neuroendocrinology. - : S. Karger AG. - 0028-3835 .- 1423-0194. ; 110:11-12, s. 891-898
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Little is known about how Pancreatic Neuroendocrine Tumors (PanNETs) evolve over time and if changes towards a more aggressive biology correlates with prognosis. The purpose of this study was to characterize changes PanNET differentiation and proliferation over time, and to correlate findings to overall survival (OS).PATIENTS AND METHODS: In this retrospective cohort study we screened 475 PanNET patients treated at Uppsala University Hospital, Sweden. Sporadic patients with baseline and follow-up tumor samples were included. Pathology reports and available tissue sections were re-evaluated with regard to tumor histopathology and Ki-67 index.RESULTS: Forty-six patients with 106 tumor samples (56 available for pathology re-evaluation) were included. Median Ki-67 index at diagnosis was 7% (range 1-38%), grade 1 n=8, grade 2 n=36, and grade 3 n=2. The median change in Ki-67 index (absolute value; follow-up - baseline) was +14% (range -11 to +80%). Increase in tumor grade occurred in 28 patients (63.6%), the majority from grade 1/2 to grade 3 (n=24, 54.5%). The patients with a high-grade progression had a median OS of 50.2 months compared to 115.1 months in patients without such progression (HR 3.89, 95% CI 1.91-7.94, P<0.001).CONCLUSIONS: A longitudinal increase in Ki-67 index and increase in tumor grade were observed in a majority of PanNETs included in this study. We propose that increase in Ki-67 index and high-grade progression should be investigated further as important biomarkers in PanNET.
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| 2. |
- Fransson, Claes, et al.
(författare)
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Late spectral evolution of the ejecta and reverse shock in SN 1987a
- 2013
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Ingår i: Astrophysical Journal. - 0004-637X .- 1538-4357. ; 768:1, s. 88-
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Tidskriftsartikel (refereegranskat)abstract
- We present observations with the Very Large Telescope and Hubble Space Telescope (HST) of the broad emission lines from the inner ejecta and reverse shock of SN 1987A from 1999 February until 2012 January (days 4381-9100 after explosion). We detect broad lines from H alpha, H beta, Mg I], Na I, [O I], [Ca II], and a feature at similar to 9220 angstrom. We identify the latter line with Mg II lambda lambda 9218, 9244, which is most likely pumped by Ly alpha fluorescence. H alpha and H beta both have a centrally peaked component extending to similar to 4500 km s(-1) and a very broad component extending to greater than or similar to 11,000 km s(-1), while the other lines have only the central component. The low-velocity component comes from unshocked ejecta, heated mainly by X-rays from the circumstellar environment, whereas the very broad component comes from faster ejecta passing through the reverse shock, created by the collision with the circumstellar ring. The flux in H alpha from the reverse shock has increased by a factor of four to six from 2000 to 2007. After that there is a tendency of flattening of the light curve, similar to what may be seen in the optical lines from the shocked ring. The core component seen in H alpha, [Ca II], and Mg II has experienced a similar increase, which is consistent with that found from HST photometry. The energy deposition of the external X-rays is calculated using explosion models for SN 1987A and we predict that the outer parts of the unshocked ejecta will continue to brighten because of this. The external X-ray illumination also explains the edge-brightened morphology of the ejecta seen in the HST images. We finally discuss evidence for dust in the ejecta from line asymmetries.
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| 3. |
- Kjaer, Josefin, et al.
(författare)
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Benefit of Primary Tumor Resection in Stage IV, Grade 1 and 2, Pancreatic Neuroendocrine Tumors : A Propensity-Score Matched Cohort Study
- 2022
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Ingår i: Annals of Surgery Open. - : Wolters Kluwer. - 2691-3593. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the association of primary tumor resection in stage IV pancreatic neuroendocrine tumors (Pan-NET) and survival in a propensity-score matched study.Background: Pan-NET are often diagnosed with stage IV disease. The oncologic benefit from primary tumor resection in this scenario is debated and previous studies show contradictory results.Methods: Patients from 3 tertiary referral centers from January 1, 1985, through December 31, 2019: Uppsala University Hospital (Uppsala, Sweden), Sahlgrenska University Hospital (Gothenburg, Sweden), and Brigham and Women’s Hospital/Dana-Farber Cancer Institute (Boston, USA) were assessed for eligibility. Patients with sporadic, grade 1 and 2, stage IV pan-NET, with baseline 2000–2019 were divided between those undergoing primary tumor resection combined with oncologic treatment (surgery group [SG]), and those who received oncologic treatment without primary tumor resection (non-SG). A propensity-score matching was performed to account for the variability in the extent of metastatic disease and comorbidity. Primary outcome was overall survival.Results: Patients with stage IV Pan-NET (n = 733) were assessed for eligibility, 194 were included. Patients were divided into a SG (n = 65) and a non-SG (n = 129). Two isonumerical groups with 50 patients in each group remained after propensity-score matching. The 5-year survival was 65.4% (95% CI, 51.5-79.3) in the matched SG and 47.8% (95% CI, 30.6-65.0) in the matched non-SG (log-rank, P = 0.043).Conclusions: Resection of the primary tumor in patients with stage IV Pan-NET and G1/G2 grade was associated with prolonged overall survival compared to nonoperative management. A surgically aggressive regime should be considered where resection is not contraindicated.
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| 4. |
- Kjaer, Josefin, et al.
(författare)
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Long-term outcome after resection and thermal hepatic ablation of pancreatic neuroendocrine tumour liver metastases
- 2021
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Ingår i: BJS open. - : Oxford University Press (OUP). - 2474-9842. ; 5:4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pancreatic neuroendocrine tumours (Pan-NETs) are rare tumours that often present with or develop liver metastases. The aim of this retrospective study was to evaluate liver surgery and thermal hepatic ablation (THA) of Pan-NET liver metastases and to compare the outcomes with those of a control group. METHOD: Patients with Pan-NET treated in Uppsala University Hospital and Sahlgrenska University Hospital from 1995-2018 were included. Patient records were scrutinized for baseline parameters, survival, treatment and complications. RESULTS: Some 108 patients met the criteria for inclusion; 57 patients underwent treatment with liver surgery or THA and 51 constitute the control group. Median follow-up was 3.93years. Five-year survival in the liver surgery/THA group was 70.6 (95 per cent c.i. 0.57 to 0.84) per cent versus 42.4 (95 per cent c.i. 40.7 to 59.1) per cent in the control group (P=0.016) and median survival was 9.1 (95 per cent c.i. 6.5 to 11.7) versus 4.3 (95 per cent c.i. 3.4-5.2) years. In a multivariable analysis, surgery or THA was associated with a decreased death-years rate (hazard ratio 0.403 (95 per cent c.i. 0.208 to 0.782, P=0.007). CONCLUSION: Liver surgery and/or THA was associated with longer overall survival in Pan-NET with acceptable mortality and morbidity rates. These treatments should thus be considered in Pan-NET patients with reasonable tumour burden in an intent to alleviate symptoms and to improve survival.
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| 5. |
- Larsson, Josefin, et al.
(författare)
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The morphology of the ejecta in supernova 1987a : A study over time and wavelength
- 2013
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Ingår i: Astrophysical Journal. - 0004-637X .- 1538-4357. ; 768:1, s. 89-
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Tidskriftsartikel (refereegranskat)abstract
- We present a study of the morphology of the ejecta in Supernova 1987A based on images and spectra from the Hubble Space Telescope (HST) as well as integral field spectroscopy from VLT/SINFONI. The HST observations were obtained between 1994 and 2011 and primarily probe the outer H-rich zones of the ejecta. The SINFONI observations were obtained in 2005 and 2011 and instead probe the [Si I]+[Fe II] emission from the inner regions. We find a strong temporal evolution of the morphology in the HST images, from a roughly elliptical shape before similar to 5000 days, to a more irregular, edge-brightened morphology with a "hole" in the middle thereafter. This transition is a natural consequence of the change in the dominant energy source powering the ejecta, from radioactive decay before similar to 5000 days to X-ray input from the circumstellar interaction thereafter. The [Si I]+[Fe II] images display a more uniform morphology, which may be due to a remaining significant contribution from radioactivity in the inner ejecta and the higher abundance of these elements in the core. Both the Ha and the [Si I]+[Fe II] line profiles show that the ejecta are distributed fairly close to the plane of the inner circumstellar ring, which is assumed to define the rotational axis of the progenitor star. The Ha emission extends to higher velocities than [Si I]+[Fe II], as expected from theoretical models. There is no clear symmetry axis for all the emission. Instead, we find that the emission is concentrated to clumps and that the emission is distributed somewhat closer to the ring in the north than in the south. This north-south asymmetry may be partially explained by dust absorption. We compare our results with explosion models and find some qualitative agreement, but note that the observations show a higher degree of large-scale asymmetry.
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