Fischer L, Kleeff J, Esposito I, Hinz U, Zimmermann A, Friess H, Büchler M W
Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Br J Surg. 2008 May;95(5):627-35. doi: 10.1002/bjs.6051.
The aim was to assess the clinical relevance of the World Health Organization and tumour node metastasis (TNM) classifications in patients with pancreatic neuroendocrine tumours (pNETs).
Prospectively collected data from 118 consecutive patients with a pNET receiving surgical intervention were analysed.
Forty-one patients had well differentiated neuroendocrine tumours, 64 had well differentiated neuroendocrine carcinomas and 13 had poorly differentiated neuroendocrine carcinomas. Five-year survival rates were 95, 44 and 0 per cent respectively (P < 0.001). There was no difference in survival after R0 and R1/R2 resections in patients with neuroendocrine carcinomas (P = 0.905). In those with well differentiated neuroendocrine carcinomas, any resection and having a clinically non-functional tumour significantly increased survival (P = 0.003 and P = 0.037 respectively). The TNM stage was I in 37 patients, II in 15 patients, III in 32 patients and IV in 34 patients. There were significant differences in 5-year survival between stage I and II (88 and 85 per cent respectively) and stage III and IV (31 and 42 per cent respectively) (P = 0.010).
Both classifications accurately reflect the clinical outcome of patients with pNET. The resection status may not be critical for long-term survival in patients with pNET.
目的是评估世界卫生组织分类和肿瘤淋巴结转移(TNM)分类在胰腺神经内分泌肿瘤(pNETs)患者中的临床相关性。
对前瞻性收集的118例接受手术干预的连续性pNET患者的数据进行分析。
41例患者为高分化神经内分泌肿瘤,64例为高分化神经内分泌癌,13例为低分化神经内分泌癌。五年生存率分别为95%、44%和0%(P<0.001)。神经内分泌癌患者R0切除和R1/R2切除后的生存率无差异(P=0.905)。在高分化神经内分泌癌患者中,任何切除以及患有临床无功能性肿瘤均显著提高生存率(分别为P=0.003和P=0.037)。TNM分期为I期的患者有37例,II期15例,III期32例,IV期34例。I期和II期(分别为88%和85%)以及III期和IV期(分别为31%和42%)的五年生存率存在显著差异(P=0.010)。
两种分类均准确反映了pNET患者的临床结局。切除状态可能对pNET患者的长期生存并非关键因素。