Kim Joo Young, Kim Min-Sun, Kim Ki-Suk, Song Ki-Byung, Lee Seung Hun, Hwang Dae Wook, Kim Kyu-Pyo, Kim Hyoung Jung, Yu Eunsil, Kim Song Cheol, Jang Hyeung-Jin, Hong Seung-Mo
Departments of *Pathology **Radiology Divisions of ∥Hepatobiliary and Pancreas Surgery ¶Endocrinology and Metabolism #Oncology, Asan Medical Center, University of Ulsan College of Medicine ‡Asan Institute for Life Science, Asan Medical Center †Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine §Department of Biochemistry, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea.
Am J Surg Pathol. 2015 May;39(5):592-601. doi: 10.1097/PAS.0000000000000383.
Pancreatic neuroendocrine tumors (PanNETs) produce variable peptide hormones. The expression status of some hormones has been linked to the biological and clinical behaviors of PanNETs. A total of 226 surgically resected PanNETs were selected. Immunolabeling for peptide hormones was compared with various clinicopathologic factors, including patient survival. Expression of insulin, glucagon-like peptide 1, glucagon, gastrin, somatostatin, and serotonin were observed in 56 (24.8%), 41 (18.1%), 25 (11.1%), 5 (2.2%), 5 (2.2%), and 4 (1.8%) cases, respectively. Expression of 1, 2, and 3 hormones was noted in 70 (31.0%), 28 (12.4%), and 3 (1.3%) cases, respectively; 125 cases (55.3%) were negative for all hormones. PanNETs with insulin and glucagon-like peptide 1 expression were associated with a lower grade, smaller size, lower pT and pN classifications, absence of lymphovascular invasion, and lymph node metastasis and had better survival by univariate analysis, whereas PanNETs with gastrin expression were associated with a higher grade, larger size, higher pT and pN classifications, presence of lymphovascular invasion, and lymph node metastasis and had worse survival. Gastrin expression, increased age, and tumor grade were negative prognostic factors in multivariate analysis. As the number of hormones expressed increased, the survival rate of PanNET patients increased. In summary, PanNET patients showing insulin or glucagon-like peptide 1 expression and increased numbers of expressed hormones had a better survival outcome by univariate analysis, whereas gastrin expression was a negative prognostic indicator in surgically resected PanNET patients.
胰腺神经内分泌肿瘤（PanNETs）可产生多种肽类激素。某些激素的表达状态与PanNETs的生物学行为和临床特征相关。本研究共纳入226例接受手术切除的PanNETs患者。将肽类激素的免疫标记结果与包括患者生存情况在内的多种临床病理因素进行比较。胰岛素、胰高血糖素样肽1、胰高血糖素、胃泌素、生长抑素和5-羟色胺的表达分别见于56例（24.8%）、41例（18.1%）、25例（11.1%）、5例（2.2%）、5例（2.2%）和4例（1.8%）。分别有70例（31.0%）、28例（12.4%）和3例（1.3%）患者表达1种、2种和3种激素；125例（55.3%）患者所有激素均呈阴性表达。单因素分析显示，表达胰岛素和胰高血糖素样肽1的PanNETs患者肿瘤分级较低、肿瘤较小、pT和pN分期较低、无脉管侵犯及淋巴结转移，生存情况较好；而表达胃泌素的PanNETs患者肿瘤分级较高、肿瘤较大、pT和pN分期较高、存在脉管侵犯及淋巴结转移，生存情况较差。多因素分析显示，胃泌素表达、年龄增加和肿瘤分级是阴性预后因素。随着表达激素数量的增加，PanNETs患者的生存率升高。总之，单因素分析显示，表达胰岛素或胰高血糖素样肽1以及表达激素数量增加的PanNETs患者生存结局较好，而胃泌素表达是手术切除的PanNETs患者的阴性预后指标。
