Ferrone Cristina R, Tang Laura H, Tomlinson James, Gonen Mithat, Hochwald Steven N, Brennan Murray F, Klimstra David S, Allen Peter J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, Howard 1223, 1275 York Ave, New York, NY 10021, USA.
J Clin Oncol. 2007 Dec 10;25(35):5609-15. doi: 10.1200/JCO.2007.12.9809.
The WHO classification for well-differentiated pancreatic endocrine neoplasms (PENs) incorporates both stage and grade. This study compares the prognostic value of a simplified staging and grading system with the WHO system in a large single-institution study.
A prospective database (1982 to 2005) identified 183 patients who underwent operative treatment for PENs. Tumors were staged (< 2 cm primary, >/= 2 cm primary, or metastases) and graded (low grade: no necrosis and < two mitoses/50 high-powered fields [HPF]; or intermediate grade: necrosis and/or >/= two mitoses/50 HPF) with a simplified schema. Influence of stage and grade on recurrence and disease-specific survival (DSS) was determined. Prognostic strength was assessed with the concordance index (CI).
Median age of the 183 patients was 56 years, and 53% were women. Median follow-up time was 44 months (range, 1 to 226 months). Classification identified 28 patients (15%) with WHO 1.1 disease, 74 (41%) with 1.2 disease, and 81 (44%) with 2.0 disease. Classification by stage identified 35 patients (19%) with tumors less than 2 cm, 96 (52%) with tumors >/= 2 cm, and 52 (29%) with nodal or distant metastases. Tumors were low grade in 102 patients (56%). Earlier stage tumors were more likely to be low grade (< 2 cm, 83%; >/= 2 cm, 61%; metastases, 28%; P < .001). The WHO classification, tumor stage, and grade were associated with 5-year DSS (P < .001). Tumors >/= 2 cm or metastases are stratified by grade (5-year DSS rate for low v intermediate grade: >/= 2 cm, 97% v 80%, respectively; P < .001; metastases, 93% v 62%, respectively; P = .05). The CI was 0.72 for WHO, 0.71 for stage, 0.66 for grade, and 0.76 for stage combined with grade.
Accurate prognostic information can be obtained by combining tumor size and metastases with simple grading information based on necrosis and mitotic rate.
世界卫生组织（WHO）对高分化胰腺内分泌肿瘤（PENs）的分类纳入了分期和分级。本研究在一项大型单机构研究中比较了简化分期和分级系统与WHO系统的预后价值。
一个前瞻性数据库（1982年至2005年）确定了183例接受PENs手术治疗的患者。采用简化方案对肿瘤进行分期（原发肿瘤<2 cm、原发肿瘤≥2 cm或有转移）和分级（低级别：无坏死且每50个高倍视野[HPF]有丝分裂数<2个；或中级别：有坏死和/或每50个HPF有丝分裂数≥2个）。确定分期和分级对复发和疾病特异性生存（DSS）的影响。用一致性指数（CI）评估预后强度。
183例患者的中位年龄为56岁，53%为女性。中位随访时间为44个月（范围1至226个月）。分类确定28例（15%）患者为WHO 1.1期疾病，74例（41%）为1.2期疾病，81例（44%）为2.0期疾病。按分期分类，35例（19%）患者的肿瘤<2 cm，96例（52%）患者的肿瘤≥2 cm，52例（29%）患者有淋巴结转移或远处转移。102例（56%）患者的肿瘤为低级别。早期肿瘤更可能为低级别（<2 cm，83%；≥2 cm，61%；有转移，28%；P<.001）。WHO分类、肿瘤分期和分级与5年DSS相关（P<.001）。肿瘤≥2 cm或有转移的患者按分级分层（低级别与中级别5年DSS率：≥2 cm，分别为97%对80%；P<.001；有转移，分别为93%对62%；P=.05）。WHO分类的CI为0.72，分期为0.71，分级为0.66，分期与分级联合为0.76。
通过将肿瘤大小和转移情况与基于坏死和有丝分裂率的简单分级信息相结合，可获得准确的预后信息。
