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Sökning: WFRF:(Kjaer Josefine)

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1.
  • Heidsma, Charlotte M, et al. (författare)
  • International Validation of a Nomogram to Predict Recurrence after Resection of Grade 1 and 2 Nonfunctioning Pancreatic Neuroendocrine Tumors
  • 2022
  • Ingår i: Neuroendocrinology. - : S. Karger. - 0028-3835 .- 1423-0194. ; 112:6, s. 571-579
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Despite the low recurrence rate of resected nonfunctional pancreatic neuroendocrine tumors (NF-pNETs), nearly all patients undergo long-term surveillance. A prediction model for recurrence may help select patients for less intensive surveillance or identify patients for adjuvant therapy. The objective of this study was to assess the external validity of a recently published model predicting recurrence within 5 years after surgery for NF-pNET in an international cohort. This prediction model includes tumor grade, lymph node status and perineural invasion as predictors.METHODS: Retrospectively, data were collected from 7 international referral centers on patients who underwent resection for a grade 1-2 NF-pNET between 1992 and 2018. Model performance was evaluated by calibration statistics, Harrel's C-statistic, and area under the curve (AUC) of the receiver operating characteristic curve for 5-year recurrence-free survival (RFS). A sub-analysis was performed in pNETs >2 cm. The model was improved to stratify patients into 3 risk groups (low, medium, high) for recurrence.RESULTS: Overall, 342 patients were included in the validation cohort with a 5-year RFS of 83% (95% confidence interval [CI]: 78-88%). Fifty-eight patients (17%) developed a recurrence. Calibration showed an intercept of 0 and a slope of 0.74. The C-statistic was 0.77 (95% CI: 0.70-0.83), and the AUC for the prediction of 5-year RFS was 0.74. The prediction model had a better performance in tumors >2 cm (C-statistic 0.80).CONCLUSIONS: External validity of this prediction model for recurrence after curative surgery for grade 1-2 NF-pNET showed accurate overall performance using 3 easily accessible parameters. This model is available via www.pancreascalculator.com.
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3.
  • Kjaer, Josefine, et al. (författare)
  • Overall Survival in Patients with Stage IV Pan-NET Eligible for Liver Transplantation
  • 2023
  • Ingår i: World Journal of Surgery. - : Springer Nature. - 0364-2313 .- 1432-2323. ; 47, s. 340-347
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The use of liver transplantation (LT) in patients with stage IV neuroendocrine pancreatic tumors (pan-NET) is under debate. Previous studies report a 5-year survival of 27-53% after LT in pan-NET and up to 92.7% in patients with mixed NETs. This study aimed to determine survival rates of patients with stage IV pan-NET meeting criteria for LT while only subjected to multimodal treatment.METHODS: Medical records of patients with pan-NET diagnosed from 2000 to 2021 at a tertiary referral center were evaluated for eligibility. Patients without liver metastases, who did not undergo primary tumor surgery, age > 75 years and with grade 3 tumors were excluded. The patients were divided into groups; all included patients, patients meeting the Milan, the United Network for Organ Sharing (UNOS) or the European Neuroendocrine Tumor Society (ENETS) criteria for LT. Kaplan-Meier survival analysis was used to calculate overall survival.RESULTS: Out of 519 patients with pan-NET, 41 patients were included. Mean follow-up time was 5.4 years. Overall survival was 9.3 years (95% Cl 6.8-11.7), and 5-year survival was 64.7% (95% CI 48.2-81.2). Patients meeting the Milan, ENETS and UNOS criteria for LT had a 5-year survival of 64.9% (95% CI 32.2-97.6), 85.7% (95% CI 59.8-100.0) and 55.4% (95% CI 26.0-84.8), respectively.CONCLUSIONS: In patients with stage IV pan-NET, grade 1 and 2, with no extra abdominal disease, 5-year survival was 64.7% (95% CI 48.2-81.2). As these survival rates exceed previously published series of LT for pan-NET, the evidence base for this treatment is very weak.
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4.
  • Kjaer, Josefine, 1985- (författare)
  • Pancreatic Neuroendocrine Tumors : Surgical Treatment and Follow-up
  • 2023
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Pancreatic neuroendocrine tumors (Pan-NET), are rare, heterogenous and derive from the hormone producing cells in the pancreas. The functioning tumors that overproduce hormones cause clinical syndromes with specific symptoms due to the hormonal production. However, the majority of patients have non-functioning tumors, and in lack of symptoms, these more often present with, or develop, liver metastases. This thesis focuses on treatment of metastasized pan-NET, stage IV, from a surgical perspective. As some patients operated on for localized disease eventually experience recurrence, it would also be beneficial to be able to predict which patients that are at a higher risk for recurrence.         In paper I, outcome after primary tumor resection in pan-NET patients, stage IV, was evaluated. An association between primary tumor resection and prolonged survival was found in patients, both before and after propensity score match. In paper II, outcome after hepatic resection and thermal hepatic ablation of liver metastases, in patients previously subjected to primary tumor resection, was scrutinized. Survival rates were significantly higher in the hepatic resection/thermal hepatic ablation group, and in a multivariable analysis, hepatic resection/thermal hepatic ablation remained a significant positive prognostic factor for prolonged survival. In paper III, patients with unresectable liver metastases, eligible for liver transplantation were investigated. A very small group of all pan-NET stage IV patients was eligible for liver transplantation and even fewer patients met any of the current selection criteria for liver transplantation. The survival rates for these patients, only subjected to multimodal treatment, were comparable to the survival rates after liver transplantation, presented in previously published studies. In paper IV, an external validation of a prediction model for recurrence after resection of non-metastatic, non-functioning, grade 1-2 tumors, was performed. The model performed well in the validation and is available online.To conclude, both primary tumor resection and surgical and ablative treatment of liver metastases in stage IV pan-NET, were associated with prolonged survival in analyses controlling for bias and possible confounders. However, the evidence base to perform liver transplantation in patients with pan-NET is weak. A prediction model for recurrence after radical surgery of non-metastatic pan-NET was externally validated with success. Our findings provide additional knowledge regarding treatment of stage IV pan-NET and could also help us predict which patients that will recur after surgery.
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