Departments of Surgery and Pathology, University of Verona, Verona, Italy.
JAMA Surg. 2013 Oct;148(10):932-9. doi: 10.1001/jamasurg.2013.3376.
Nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) are often indolent neoplasms without lymph node (LN) metastasis at diagnosis. Therefore, in patients with low risk of LN metastasis, the extent of surgery and lymphadenectomy could be limited and follow-up adjusted to the very low risk of relapse.
To construct a predicting model to assess the risk of pN+ prior to surgical resection for NF-PanNETs using preoperative retrievable variables.
Retrospective review using multiple logistic regression analysis to construct predictive model of pN+ based on preoperatively available data.
The combined prospective databases of the Surgical Departments of the University of Verona, Verona, Italy, and Beaujon Hospital, Clichy, France, were queried for clinical and pathological data.
All patients with resected (R0 or R1), pathologically confirmed NF-PanNETs between January 1, 1993 and December 31, 2009.
Risk of lymph node metastases in patients with pancreatic neuroendocrine tumors.
Among 181 patients, nodal metastases were reported in 55 patients (30%) and were associated with decreased 5-year disease-free survival (70% vs 97%, P < .001). Multivariable analysis showed that independent factors associated with nodal metastasis were radiological nodal status (rN) (odds ratio [OR], 5.58; P < .001) and tumor grade (NET-G2 vs NET-G1: OR, 4.87; P < .001) (first model). When the tumor grade was excluded, rN (OR, 4.73; P = .001) and radiological tumor size larger than 4 cm (OR, 2.67; P = .03) were independent predictors of nodal metastasis (second model). The area under the receiver operating characteristic curve for the first and second models were 80% and 74%, respectively.
Patients with NF-PanNET-G1 have a very low risk of pN+ in the absence of radiological signs of node involvement. When preoperative grading assessment is not achieved, the radiological size of the lesion is a powerful alternative predictor of pN+. The risk of pathological nodal involvement in patients with NF-PanNETs can be accurately estimated by a clinical predictive model.
无功能性胰腺神经内分泌肿瘤（NF-PanNETs）通常是惰性肿瘤，在诊断时无淋巴结（LN）转移。因此，在 LN 转移风险低的患者中，可以限制手术范围和淋巴结清扫，并根据复发风险极低的情况进行随访调整。
使用术前可获取的变量，构建一个预测模型来评估 NF-PanNET 手术前 pN+的风险。
使用多变量逻辑回归分析对前瞻性数据库进行回顾性分析，以构建基于术前数据的 pN+预测模型。
意大利维罗纳大学外科系和法国克利希博让医院的前瞻性数据库联合检索临床和病理数据。
所有接受 R0 或 R1 切除、病理证实的 NF-PanNETs 患者，纳入时间为 1993 年 1 月 1 日至 2009 年 12 月 31 日。
胰腺神经内分泌肿瘤患者的淋巴结转移风险。
在 181 例患者中，55 例（30%）患者存在淋巴结转移，与 5 年无病生存率降低相关（70%比 97%，P < .001）。多变量分析显示，与淋巴结转移相关的独立因素包括影像学淋巴结状态（rN）（优势比 [OR]，5.58；P < .001）和肿瘤分级（NET-G2 比 NET-G1：OR，4.87；P < .001）（第一模型）。当排除肿瘤分级时，rN（OR，4.73；P = .001）和影像学肿瘤大小大于 4 cm（OR，2.67；P = .03）是淋巴结转移的独立预测因子（第二模型）。第一和第二模型的受试者工作特征曲线下面积分别为 80%和 74%。
无影像学淋巴结受累征象的 NF-PanNET-G1 患者 pN+的风险非常低。当术前分级评估不可行时，病变的影像学大小是预测 pN+的有力替代指标。NF-PanNET 患者的病理性淋巴结受累风险可以通过临床预测模型准确估计。
