Fitzgerald Timothy L, Mosquera Catalina, Vora Haily S, Vohra Nasreen A, Zervos Emmanuel E
Division of Surgical Oncology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.
Am Surg. 2016 Aug;82(8):737-42.
The role of surgical resection in low-grade pancreatic neuroendocrine tumors (P-NET) is unclear. The patients diagnosed with low-grade P-NET from 1988 to 2012 were identified in SEER. Five hundred and sixty-one patients met the inclusion criteria. A majority were white (82.9%), and node negative (69.9%). Univariate analysis revealed that tumor size (<2 cm 8.3%, 2-4 cm 38.5%, and >4 cm 40.3%; P < 0.0001) and surgery (30.9% vs 25.3%; P = 0.0014) were associated with the risk of lymph node metastases (LNM). In contrast, age (P = 0.8360), gender (P = 0.4903), and race (P = 0.4235) were not. Five-year disease-free survival was associated with size (<2 cm 89.4%, 2-4 cm 80.0%, and >4 cm 74.5%; P = 0.0089), LNM (72.4% vs 82.9%; P = 0.0025), and surgery (84.3% vs 47.5%; P < 0.0001). Cox regression model showed that the association with LNM (P = 0.0025) and surgery (P < 0.0001) was significant. Surgery was associated with an improved disease-free survival for tumors >2 cm (2-4 cm, 84.4% vs 26.0% at five years; P = 0.0003, and >4 cm, 80.5% vs 49.5% at five years; P < 0.0001) but not for those with tumor size <2 cm (P = 0.4525). In conclusions, low-grade P-NETs in patients with tumor size >2 cm showed an increased risk of LNM and improved survival with resection.
手术切除在低级别胰腺神经内分泌肿瘤（P-NET）中的作用尚不清楚。我们在监测、流行病学和最终结果（SEER）数据库中识别出1988年至2012年期间诊断为低级别P-NET的患者。561例患者符合纳入标准。大多数患者为白人（82.9%），且无淋巴结转移（69.9%）。单因素分析显示，肿瘤大小（<2 cm占8.3%，2 - 4 cm占38.5%，>4 cm占40.3%；P < 0.0001）和手术（30.9%对25.3%；P = 0.0014）与淋巴结转移（LNM）风险相关。相比之下，年龄（P = 0.8360）、性别（P = 0.4903）和种族（P = 0.4235）则无此关联。五年无病生存率与肿瘤大小（<2 cm占89.4%，2 - 4 cm占80.0%，>4 cm占74.5%；P = 0.0089）、LNM（72.4%对82.9%；P = 0.0025）和手术（84.3%对47.5%；P < 0.0001）相关。Cox回归模型显示，与LNM（P = 0.0025）和手术（P < 0.0001）的关联具有显著性。对于肿瘤>2 cm的患者，手术与无病生存率的提高相关（2 - 4 cm者，五年时为84.4%对26.0%；P = 0.0003，>4 cm者，五年时为80.5%对49.5%；P < 0.0001），但对于肿瘤大小<2 cm的患者则不然（P = 0.4525）。总之，肿瘤大小>2 cm的低级别P-NET患者显示出LNM风险增加，手术切除可改善生存率。
