Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy.
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
J Endocrinol Invest. 2015 Jun;38(6):605-13. doi: 10.1007/s40618-014-0219-x. Epub 2014 Dec 12.
Non-functioning (NF) pancreatic neuroendocrine tumors (pNET) often have an indolent outcome. A consensus to submit patients with large (>2 cm) NF-pNET to surgery already exists; but a conservative approach for small (≤2 cm) NF neoplasms has been proposed.
To identify prognostic factors for survival and progression free survival (PFS) of NF-pNET, evaluating whether surgery may be avoided for small NF-pNET.
Retrospective study of 77 consecutive patients with pNET submitted to surgery, of which 60 were NF. Pathological tissues were revised according to the 2000 and 2010 WHO classifications. Risk factors for survival and PFS were evaluated using the Kaplan-Meier method and the Cox regression model.
The 8-year cause-specific survival of NF-pNET was 79.3%. At univariate analysis, high grading, high staging, large tumors, angioinvasion and peri-pancreatic infiltration were significantly associated with a shorter survival; at multivariate analysis only peri-pancreatic infiltration was significantly associated with a shorter NF-pNET survival. Most small NF-pNET were grade 1 (74%), compared to large NF-pNET (27%). Distant metastases were present in 29.7% (n = 11) and 17.4% (n = 4) of patients with large or small NF-pNET, respectively; among the 19 small NF-pNET without metastasis, five had a local malignancy (lymph node metastasis or local infiltration); thus, 39% of the 23 NF-pNET, turned out to have a malignant potential.
Among NF-pNET, large neoplasms were associated with worse outcomes; however, small NF-pNET do not seem to have an invariable benign behavior. Whether surgery should be avoided in all patients with small NF-pNET is questionable.
无功能性（NF）胰腺神经内分泌肿瘤（pNET）通常表现为惰性病程。目前已经达成共识，即对于大（>2cm）NF-pNET 患者应进行手术治疗；然而，对于小（≤2cm）NF 肿瘤，已提出采用保守治疗方法。
确定 NF-pNET 患者生存和无进展生存期（PFS）的预后因素，评估是否可以避免对小 NF-pNET 进行手术。
回顾性研究了 77 例接受手术治疗的 pNET 患者，其中 60 例为 NF 型。根据 2000 年和 2010 年 WHO 分类对病理组织进行了修订。采用 Kaplan-Meier 法和 Cox 回归模型评估生存和 PFS 的危险因素。
NF-pNET 的 8 年特异性生存率为 79.3%。单因素分析显示，高级别、高分期、大肿瘤、血管侵犯和胰周浸润与生存率缩短显著相关；多因素分析仅显示胰周浸润与 NF-pNET 生存率缩短显著相关。大多数小 NF-pNET 为 1 级（74%），而大 NF-pNET 为 27%。大 NF-pNET 中有 29.7%（n=11）和小 NF-pNET 中有 17.4%（n=4）的患者发生远处转移；在 19 例无转移的小 NF-pNET 中，5 例发生局部恶性肿瘤（淋巴结转移或局部浸润）；因此，23 例 NF-pNET 中有 39%具有恶性潜能。
在 NF-pNET 中，大肿瘤与预后较差相关；然而，小 NF-pNET 似乎并不具有不变的良性行为。是否应避免对所有小 NF-pNET 患者进行手术治疗仍存在疑问。
