Guopei Luo, Kaizhou Jin, Chen Liu, Jin Xu, Quanxing Ni, and Xianjun Yu, Fudan University Shanghai Cancer Center; Chenghao Shao, Shanghai Changzheng Hospital; Wei Wang, Huadong Hospital, Fudan University, Shanghai; Yu Zhang, Minhu Chen, and Jie Chen, The First Affiliated Hospital, Sun Yat-Sen University; Wei Wang, Sun Yat-sen University Cancer Center; Jian Sun, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou; Huangying Tan, China-Japan Friendship Hospital; and Jie Li and Lin Shen, Peking University Cancer Hospital and Institute, Beijing, China; Ammar Javed, Kevin Soares, Matthew J. Weiss, Lei Zheng, Christopher L. Wolfgang, and Jin He, The Johns Hopkins University School of Medicine, Baltimore, MD; and Jonathan R. Strosberg, Mauro Cives, and Joyce Wong, Moffitt Cancer Center and Research Institute, Tampa, FL.
J Clin Oncol. 2017 Jan 20;35(3):274-280. doi: 10.1200/JCO.2016.67.8193. Epub 2016 Sep 30.
Purpose The European Neuroendocrine Tumor Society (ENETS) and the American Joint Committee on Cancer (AJCC) staging classifications are two widely used systems in managing pancreatic neuroendocrine tumors. However, there is no universally accepted system. Methods An analysis was performed to evaluate the application of the ENETS and AJCC staging classifications using the SEER registry (N = 2,529 patients) and a multicentric series (N = 1,143 patients). A modified system was proposed based on analysis of the two existing classifications. The modified system was then validated. Results The proportion of patients with AJCC stage III disease was extremely low for both the SEER series (2.2%) and the multicentric series (2.1%). For the ENETS staging system, patients with stage I disease had a similar prognosis to patients with stage IIA disease, and patients with stage IIIB disease had a lower hazard ratio for death than did patients with stage IIIA disease. We modified the ENETS staging classification by maintaining the ENETS T, N, and M definitions and adopting the AJCC staging definitions. The proportion of patients with stage III disease using the modified ENETS (mENETS) system was higher than that of the AJCC system in both the SEER series (8.9% v 2.2%) and the multicentric series (11.6% v 2.1%). In addition, the hazard ratio of death for patients with stage III disease was higher than that for patients with stage IIB disease. Moreover, statistical significance and proportional distribution were observed in the mENETS staging classification. Conclusion An mENETS staging classification is more suitable for pancreatic neuroendocrine tumors than either the AJCC or ENETS systems and can be adopted in clinical practice.
目的
欧洲神经内分泌肿瘤学会（ENETS）和美国癌症联合委员会（AJCC）分期分类是两种广泛用于管理胰腺神经内分泌肿瘤的系统。然而，目前尚无被普遍接受的系统。
方法
使用 SEER 登记处（N=2529 例患者）和多中心系列（N=1143 例患者）对 ENETS 和 AJCC 分期分类的应用进行了分析。基于对这两种现有分类的分析，提出了一种改良系统。然后对改良系统进行了验证。
结果
SEER 系列（2.2%）和多中心系列（2.1%）中，AJCC 分期为 III 期的患者比例极低。对于 ENETS 分期系统，I 期患者的预后与 IIA 期患者相似，而 IIIB 期患者的死亡风险比 IIIA 期患者低。我们通过保留 ENETS T、N 和 M 的定义并采用 AJCC 分期定义来修改 ENETS 分期分类。改良后的 ENETS（mENETS）系统在 SEER 系列（8.9%比 2.2%）和多中心系列（11.6%比 2.1%）中，III 期患者的比例均高于 AJCC 系统。此外，III 期患者的死亡风险比 IIB 期患者更高。此外，mENETS 分期分类中观察到了统计学意义和比例分布。
结论
与 AJCC 或 ENETS 系统相比，mENETS 分期分类更适合胰腺神经内分泌肿瘤，可在临床实践中采用。
