胰腺神经内分泌肿瘤的手术和分期：14 年经验。
Surgery and staging of pancreatic neuroendocrine tumors: a 14-year experience.
机构信息
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
出版信息
J Gastrointest Surg. 2010 May;14(5):891-8. doi: 10.1007/s11605-010-1173-3. Epub 2010 Mar 12.
BACKGROUND
The aims of this study were to evaluate contemporary outcomes associated with the surgical management of pancreatic neuroendocrine tumors (PNETs) and to assess the prognostic value of the World Health Organization (WHO) classification and TNM staging for PNETs.
METHODS
The medical records of 73 consecutive patients with PNETs treated at a single institution from January 1992 through September 2006 were reviewed. Survival was analyzed with the Kaplan-Meier method (median follow-up: 43 months).
RESULTS
Median patient age was 52 years (range, 19-83 years), and 36 (49%) patients were male. Thirty-three patients had a well-differentiated neuroendocrine tumor (WDT), 26 had a well-differentiated neuroendocrine carcinoma (WDCa), and 14 had a poorly differentiated neuroendocrine carcinoma (PDCa). Fifty (68%) patients underwent potentially curative resection, and the 5-year disease-specific survival (DSS) rate for the entire cohort was 62%. WHO classification and TNM staging system provided good prognostic stratification of patients; 5-year DSS rates were 100% for WDT, 57% for WDCa, 8% for PDCa, respectively, by WHO classification (p < 0.001), and 100% for stage 1, 90% for stage 2, 57% for stage 3, and 8% for stage 4, respectively, by TNM stage (p < 0.001). Among the patients who underwent potentially curative resection, nodal status, distant metastasis, and tumor grade were significant prognostic factors.
CONCLUSION
WHO classification and TNM staging are useful for prognostic stratification among patients with PNETs.
背景
本研究旨在评估与胰腺神经内分泌肿瘤（PNET）的外科治疗相关的当代结果，并评估世界卫生组织（WHO）分类和 TNM 分期对 PNET 的预后价值。
方法
回顾性分析 1992 年 1 月至 2006 年 9 月期间在一家机构接受治疗的 73 例 PNET 连续患者的病历。采用 Kaplan-Meier 方法分析生存情况（中位随访时间：43 个月）。
结果
患者年龄中位数为 52 岁（范围，19-83 岁），36 例（49%）为男性。33 例为高分化神经内分泌肿瘤（WDT），26 例为高分化神经内分泌癌（WDCa），14 例为低分化神经内分泌癌（PDCa）。50 例（68%）患者接受了潜在根治性切除术，整个队列的 5 年疾病特异性生存率（DSS）为 62%。WHO 分类和 TNM 分期系统为患者提供了良好的预后分层；按 WHO 分类，WDT 的 5 年 DSS 率为 100%，WDCa 为 57%，PDCa 为 8%（p<0.001），TNM 分期的 1 期为 100%，2 期为 90%，3 期为 57%，4 期为 8%（p<0.001）。在接受潜在根治性切除术的患者中，淋巴结状态、远处转移和肿瘤分级是显著的预后因素。
结论
WHO 分类和 TNM 分期可用于对 PNET 患者进行预后分层。
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