胰腺神经内分泌肿瘤：放射性钙化与肿瘤分级和转移相关。
Pancreatic neuroendocrine tumors: radiographic calcifications correlate with grade and metastasis.
机构信息
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
出版信息
Ann Surg Oncol. 2012 Jul;19(7):2295-303. doi: 10.1245/s10434-012-2305-7. Epub 2012 Mar 7.
BACKGROUND
Studies to identify preoperative prognostic variables for pancreatic neuroendocrine tumor (PNET) have been inconclusive. Specifically, the prevalence and prognostic significance of radiographic calcifications in these tumors remains unclear.
METHODS
From 1998 to 2009, a total of 110 patients with well-differentiated PNET underwent surgical resection at our institution. Synchronous liver metastases present in 31 patients (28%) were addressed surgically with curative intent. Patients with high-grade PNET were excluded. The presence of calcifications in the primary tumor on preoperative computed tomography was recorded and correlated with clinicopathologic variables and overall survival.
RESULTS
Calcifications were present in 16% of patients and were more common in gastrinomas and glucagonomas (50%), but never encountered in insulinomas. Calcified tumors were larger (median size 4.5 vs. 2.3 cm, P=0.04) and more commonly associated with lymph node metastasis (75 vs. 35%, P=0.01), synchronous liver metastasis (62 vs. 21%, P<0.01), and intermediate tumor grade (80 vs. 31%, P<0.01). On multivariate analysis of factors available preoperatively, calcifications (P=0.01) and size (P<0.01) remained independent predictors of lymph node metastasis. Overall survival after resection was significantly worse in the presence of synchronous liver metastasis (5-year, 64 vs. 86%, P=0.04), but not in the presence of radiographic calcifications.
CONCLUSIONS
Calcifications on preoperative computed tomography correlate with intermediate grade and lymph node metastasis in well-differentiated PNET. This information is available preoperatively and supports the routine dissection of regional lymph nodes through formal pancreatectomy rather than enucleation in calcified PNET.
背景
目前，用于识别胰腺神经内分泌肿瘤（PNET）术前预后变量的研究尚无定论。具体而言，这些肿瘤中放射性钙化的发生率及其预后意义尚不清楚。
方法
1998 年至 2009 年，我院共对 110 例分化良好的 PNET 患者进行了手术切除。31 例（28%）患者同时存在肝转移，我们采用根治性手术治疗。排除高级别 PNET 患者。记录术前 CT 检查原发性肿瘤中钙化的存在情况，并将其与临床病理变量和总体生存率相关联。
结果
16%的患者存在钙化，在胃泌素瘤和胰高血糖素瘤中更常见（50%），但从未在胰岛素瘤中遇到。钙化肿瘤较大（中位数大小 4.5 厘米 vs. 2.3 厘米，P=0.04），且更常伴有淋巴结转移（75% vs. 35%，P=0.01）、同步肝转移（62% vs. 21%，P<0.01）和中等级别肿瘤（80% vs. 31%，P<0.01）。在术前可获得的因素的多变量分析中，钙化（P=0.01）和大小（P<0.01）仍然是淋巴结转移的独立预测因素。存在同步肝转移时，切除术后的总生存率显著降低（5 年生存率为 64% vs. 86%，P=0.04），但与影像学钙化无关。
结论
术前 CT 上的钙化与分化良好的 PNET 中中等级别和淋巴结转移相关。此信息在术前即可获得，支持在钙化性 PNET 中通过正规的胰切除术而非肿瘤剜除术常规解剖区域淋巴结。
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