偶然诊断作为无功能性胰腺神经内分泌肿瘤不同肿瘤分期的预后因素。
Incidental diagnosis as prognostic factor in different tumor stages of nonfunctioning pancreatic endocrine tumors.
机构信息
Department of Surgery, Policlinico GB Rossi, University of Verona, Verona, Italy; Department of Surgery, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy.
Department of Pathology, Policlinico GB Rossi, University of Verona, Verona, Italy; Department of Pathology, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy.
出版信息
Surgery. 2014 Jan;155(1):145-53. doi: 10.1016/j.surg.2013.08.002.
BACKGROUND
Incidentally discovered nonfunctioning pancreatic endocrine tumors (NF-pNETs) increasingly are being detected, and their management is debated. Moreover, the prognostic importance of incidental diagnosis for locally advanced or metastatic NF-pNETs is unknown. The aim of this study is to analyze the outcomes of incidentally discovered/symptomatic NF-pNETs stratified by tumor stage. A preliminary experience with nonoperative treatment of incidental NF-pNETs is reported.
METHODS
Consecutive patients with symptomatic/incidental NF-PETs observed between 1990 and 2009 were analyzed, with different tumor stages considered. Nonoperative management of incidental NF-pNETs was evaluated.
RESULTS
Among 355 patients with NF-pNETs, the diagnosis was incidental in 124 (35%). Incidental NF-pNETs were associated more commonly with lower tumor stages compared with symptomatic tumors (P < .0001), but 30% of incidental NF-pNETs were stage III-IV. Incidental NF-pNETs had greater rates of radical resections and of R0 margins (P < .0001). Five-year progression-free survival (PFS) was 83% and 32% for incidental and symptomatic NF-pNETs, respectively (P < .0001). Five-year PFS was better for incidental NF-pNETs compared with symptomatic tumors for each tumor stage, including stage III (69% vs 27%, P < .0001) and stage IV (60% vs 17%, P = .112). After a median follow-up of 36 months, there was no tumor progression in 12 patients who underwent nonoperative management of incidental NF-pNETs.
CONCLUSION
A total of 30% of incidental NF-pNETs present with stage III-IV disease. PFS is much greater for incidental NF-pNETs compared with symptomatic patients, and this difference is evident also for stage III-IV tumors, suggesting that absence of symptoms may indicate a less-aggressive disease. Nonoperative management can be an alternative to surgery in selected incidental NF-pNETs.
背景
偶然发现的无功能胰腺内分泌肿瘤（NF-pNETs）越来越多地被发现，其治疗方法存在争议。此外，局部晚期或转移性 NF-pNETs 偶然诊断的预后意义尚不清楚。本研究旨在分析按肿瘤分期分层的偶然发现/症状性 NF-pNETs 的结果。报告了非手术治疗偶然 NF-pNETs 的初步经验。
方法
分析了 1990 年至 2009 年间观察到的有症状/偶然 NF-PETs 的连续患者，考虑了不同的肿瘤分期。评估了偶然 NF-pNETs 的非手术治疗。
结果
在 355 例 NF-pNETs 患者中，124 例（35%）诊断为偶然。与症状性肿瘤相比，偶然 NF-pNETs 更常见于较低的肿瘤分期（P<.0001），但 30%的偶然 NF-pNETs 为 III-IV 期。偶然 NF-pNETs 的根治性切除率和 R0 切缘率更高（P<.0001）。偶然 NF-pNETs 和症状性 NF-pNETs 的 5 年无进展生存率（PFS）分别为 83%和 32%（P<.0001）。对于每个肿瘤分期，包括 III 期（69%比 27%，P<.0001）和 IV 期（60%比 17%，P=.112），偶然 NF-pNETs 的 5 年 PFS 均优于症状性肿瘤。在中位随访 36 个月后，12 例接受偶然 NF-pNETs 非手术治疗的患者无肿瘤进展。
结论
30%的偶然 NF-pNETs 为 III-IV 期疾病。与症状性患者相比，偶然 NF-pNETs 的 PFS 更高，这种差异在 III-IV 期肿瘤中也很明显，这表明无症状可能表明疾病侵袭性较低。在选择的偶然 NF-pNETs 中，非手术治疗可能是手术的替代方法。
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