Somatostatin Analogs Versus Active Surveillance in Small Pancreatic Neuroendocrine Tumors.

Objectives: The best strategy for nonfunctioning, sporadic, G1-G2 pancreatic neuroendocrine tumors ≤2 cm is unknown. An active surveillance is usually recommended. The PROMID and the CLARINET studies proved the value of somatostatin analog (SSA) treatment in advanced gastro-entero-pancreatic neuroendocrine tumors. The aim of this study is to assess the value of SSA in pancreatic NET (PanNET) ≤ 2 cm.

Materials And Methods: We retrospectively collected data from 72 patients with sporadic nonfunctioning G1-G2 PanNETs ≤ 2 cm, which were either treated with somatostatin analogs (n = 31) or underwent active surveillance (n = 41) at our institution.

Results: At a median follow-up of 53.7 months, the median progression-free survival was not reached in the treatment group versus an estimated progression-free survival of 85 months in the control group (hazard ratio, 0.11; P  = 0.01), with a rate of progression or death up to 21.9% in the active surveillance group. Additionally, in the group of patients treated with somatostatin analogs, the response rate was 16.1% with 1 complete response.

Conclusions: Our monocentric experience demonstrated a significant antiproliferative activity of somatostatin analogs in patients with sporadic, nonfunctionating G1-G2 PanNETs ≤ 2-cm delaying tumor progression and distant spread in small lesions that sometimes may reveal unpredictable aggressiveness.