Section of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-7375, USA.
HPB (Oxford). 2009 Aug;11(5):422-8. doi: 10.1111/j.1477-2574.2009.00082.x.
A number of prognostically relevant clinicopathological variables have been proposed for pancreatic neuroendocrine neoplasms. However, a standardized prognostication system has yet to be established for patients undergoing potentially curative tumour resection.
We examined a prospectively maintained, single-institution database to identify patients who underwent potentially curative resection of non-metastatic primary pancreatic neuroendocrine neoplasms. Patient, operative and pathological characteristics were analysed to identify variables associated with disease-specific and disease-free survival.
Between 1991 and 2007, 43 patients met inclusion criteria. After a median follow-up of 68 months, 5-year disease-specific survival was 94% and 5-year disease-free survival was 72%. Tumours sized > or = 5 cm and vascular invasion were associated with worse disease-specific survival. Tumours sized > or = 5 cm, nodal metastases, positive resection margins and perineural invasion were associated with worse disease-free survival. A scoring system consisting of tumour size > or = 5 cm, histological grade, nodal metastases and resection margin positivity (SGNM) permitted stratification of disease-specific (P= 0.006) and disease-free (P= 0.0004) survival. This proposed scoring system demonstrated excellent discrimination of individual disease-specific and disease-free survival outcomes as reflected by concordance indices of 0.814 and 0.794, respectively.
A simple scoring system utilizing tumour size, histological grade, nodal metastases and resection margin status can be used to stratify outcomes in patients undergoing resection of primary pancreatic neuroendocrine neoplasms.
目前已经提出了一些与预后相关的临床病理变量用于胰腺神经内分泌肿瘤。然而，对于接受潜在可治愈肿瘤切除术的患者，尚未建立标准化的预后系统。
我们检查了一个前瞻性维持的单机构数据库，以确定接受非转移性原发性胰腺神经内分泌肿瘤潜在可治愈切除术的患者。分析患者、手术和病理特征，以确定与疾病特异性和无病生存相关的变量。
1991 年至 2007 年间，43 名患者符合纳入标准。中位随访 68 个月后，5 年疾病特异性生存率为 94%，5 年无病生存率为 72%。肿瘤大小≥5cm 和血管侵犯与疾病特异性生存不良相关。肿瘤大小≥5cm、淋巴结转移、阳性切缘和神经周围侵犯与无病生存不良相关。由肿瘤大小≥5cm、组织学分级、淋巴结转移和切缘阳性组成的评分系统（SGNM）允许对疾病特异性（P=0.006）和无病生存（P=0.0004）进行分层。该评分系统在反映个体疾病特异性和无病生存结局方面具有出色的区分能力，一致性指数分别为 0.814 和 0.794。
利用肿瘤大小、组织学分级、淋巴结转移和切缘状态的简单评分系统可用于分层接受原发性胰腺神经内分泌肿瘤切除术患者的结局。
