1 型多发性内分泌肿瘤中的胰腺术前评估。
Preoperative assessment of the pancreas in multiple endocrine neoplasia type 1.
机构信息
Division of Medical Oncology, Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
出版信息
World J Surg. 2012 Jun;36(6):1375-81. doi: 10.1007/s00268-012-1539-7.
BACKGROUND
Many serologic and radiographic modalities are used for monitoring multiple endocrine neoplasia type 1 (MEN 1) patients for pancreaticoduodenal neuroendocrine tumors (PNETs). We compared serum markers and imaging studies obtained preoperatively with the gross pathology and immunohistochemical findings and correlated preoperative testing with postoperative outcome.
METHODS
From 2000 to 2008, 52 MEN 1 patients [32 (62%) female; median age = 43 years, range 19-74 years] underwent 56 pancreatic operations [49 (88%) distal pancreatectomies] for suspected PNETs. Preoperative serum markers [human pancreatic polypeptide (HPP), gastrin, and glucagon] and imaging [CT, (111)In pentetreotide scintigraphy, and endoscopic ultrasound (EUS)] were compared to the pathologic findings. Postoperative serum markers and survival were followed.
RESULTS
Human pancreatic polypeptide had the highest agreement between an elevated serum level and positive tumor immunostaining (83% vs. 50% agreement for gastrin vs. 67% agreement for glucagon). Preoperative CT had 81% sensitivity and positive predictive value (PPV) of 97% for PNETs. (111)In pentetreotide scintigraphy had 84% sensitivity and PPV of 96%. Preoperative endoscopic ultrasonography (EUS) had 100% sensitivity and PPV, with close correlation (r (s) = 0.93) between the largest lesion seen on EUS and pathology. Median follow-up was 4.3 years (range = 0.1-10.9 years). Overall survival was 89% at 5-year follow-up.
CONCLUSIONS
Our study substantiates EUS as providing the highest preoperative sensitivity and PPV in assessing the presence of PNETs in MEN 1 patients. CT and octreotide scintigraphy can yield both false-positive and false-negative results. HPP, gastrin, and glucagon were the most commonly measured tumor markers in our series but did not always correlate with immunostaining. With an aggressive surgical approach, satisfactory rates of biochemical improvement and long-term survival were observed.
背景
许多用于监测多发性内分泌肿瘤 1 型（MEN1）患者胰十二指肠神经内分泌肿瘤（PNET）的血清学和影像学方法。我们比较了术前获得的血清标志物和影像学研究与大体病理和免疫组织化学结果，并将术前检查与术后结果相关联。
方法
2000 年至 2008 年，52 名 MEN1 患者[32 名（62%）女性；中位年龄 43 岁，范围 19-74 岁]因疑似 PNET 而行 56 例胰腺手术[49 例（88%）胰远端切除术]。比较术前血清标志物[人胰腺多肽（HPP）、胃泌素和胰高血糖素]和影像学[CT、（111）In 五肽替替奥定闪烁扫描和内镜超声（EUS）]与病理发现。随访术后血清标志物和生存情况。
结果
在升高的血清水平和阳性肿瘤免疫染色之间，人胰腺多肽具有最高的一致性（与胃泌素相比，83%与 50%的一致性，与胰高血糖素相比，67%的一致性）。术前 CT 对 PNET 的敏感性为 81%，阳性预测值（PPV）为 97%。（111）In 五肽替替奥定闪烁扫描的敏感性为 84%，PPV 为 96%。术前 EUS 的敏感性为 100%，PPV 为 100%，EUS 上所见的最大病变与病理密切相关（r（s）=0.93）。中位随访时间为 4.3 年（范围 0.1-10.9 年）。5 年随访时的总体生存率为 89%。
结论
我们的研究证实 EUS 提供了评估 MEN1 患者 PNET 存在的最高术前敏感性和阳性预测值。CT 和奥曲肽闪烁扫描可产生假阳性和假阴性结果。在我们的系列研究中，HPP、胃泌素和胰高血糖素是最常用的肿瘤标志物，但并不总是与免疫染色相关。采用积极的手术方法，观察到生化改善和长期生存的令人满意的比率。
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