Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
J Gastroenterol. 2012 Jun;47(6):678-85. doi: 10.1007/s00535-012-0540-0. Epub 2012 Feb 17.
Because of the rarity and variety of pancreatic neuroendocrine tumors (PNETs), there have been few reports regarding the indication for lymph node dissection in patients with these tumors. This study aimed to evaluate the risk of lymph node metastasis of PNETs based on the tumor size and hormonal production.
Data for a total of 66 patients who had PNETs resected at our department between 1987 and 2010 were retrospectively studied. The clinicopathological features, including the disease-specific survival rate, were assessed based on the status of lymph node metastasis at the time of initial surgical resection. Then the cut-off point of tumor size to predict lymph node metastasis was estimated.
There were 12 patients (18%) with lymph node metastasis. The frequency of lymph node metastasis tended to be higher in gastrinomas than that in other tumors (43 vs. 15%; P = 0.08). The size of PNETs with lymph node metastasis was significantly larger than that of the PNETs without metastasis (P = 0.04). The postoperative survival rate in the PNET patients with lymph node metastasis was significantly lower than that in the patients without metastasis (P < 0.0001). Only 2 (8%) of 26 PNETs with a tumor size of <15 mm had lymph node metastasis, and both of these were gastrinomas. On the other hand, 10 (25%) of the remaining 40 PNETs with a tumor size of ≥15 mm had lymph node metastasis. Notably, there were no PNETs with lymph node metastasis in 22 non-gastrinomas with a tumor size of <15 mm.
Non-gastrinomas with a tumor size of ≥15 mm and all gastrinomas would be an indication for pancreatectomy with lymph node dissection.
由于胰腺神经内分泌肿瘤（PNETs）罕见且种类繁多，因此关于这些肿瘤淋巴结清扫的适应证的报道较少。本研究旨在根据肿瘤大小和激素产生评估 PNETs 淋巴结转移的风险。
回顾性研究了 1987 年至 2010 年期间在我科接受 PNET 切除术的 66 例患者的临床病理资料。根据初始手术切除时的淋巴结转移状态评估疾病特异性生存率等临床病理特征。然后估计肿瘤大小预测淋巴结转移的临界点。
12 例（18%）患者发生淋巴结转移。胃泌素瘤的淋巴结转移频率高于其他肿瘤（43%比 15%；P=0.08）。有淋巴结转移的 PNET 肿瘤大小明显大于无转移的 PNET（P=0.04）。有淋巴结转移的 PNET 患者的术后生存率明显低于无转移的患者（P<0.0001）。仅 26 例肿瘤直径<15mm 的 PNET 中有 2 例（8%）发生淋巴结转移，且均为胃泌素瘤。另一方面，40 例肿瘤直径≥15mm 的 PNET 中有 10 例（25%）发生淋巴结转移。值得注意的是，肿瘤直径<15mm 的 22 例非胃泌素瘤中无一例发生淋巴结转移。
肿瘤直径≥15mm 的非胃泌素瘤和所有胃泌素瘤均为胰腺切除术加淋巴结清扫术的适应证。
