基于形态学的3级胰腺神经内分泌肿瘤的治疗反应和结果：高分化与低分化
Treatment Response and Outcomes of Grade 3 Pancreatic Neuroendocrine Neoplasms Based on Morphology: Well Differentiated Versus Poorly Differentiated.
作者信息
Raj Nitya, Valentino Emily, Capanu Marinela, Tang Laura H, Basturk Olca, Untch Brian R, Allen Peter J, Klimstra David S, Reidy-Lagunes Diane
机构信息
From the Departments of *Medicine, †Biostatistics, ‡Pathology, and §Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
出版信息
Pancreas. 2017 Mar;46(3):296-301. doi: 10.1097/MPA.0000000000000735.
OBJECTIVES
Emerging data suggest that not all grade 3 (G3) pancreatic neuroendocrine neoplasms (panNENs) behave the same; tumor differentiation may predict outcome.
METHODS
Patients with G3 panNENs treated at our institution between 1999 and 2014 were identified. Demographics, response to therapy, and overall survival were determined.
RESULTS
Forty-five patients were identified, 16 with G3 well differentiated pancreatic neuroendocrine tumors (WD-panNETs) and 29 with poorly differentiated neuroendocrine carcinomas (PDNEC). Median overall survival in G3 WD-panNET patients was 52.2 months (95% confidence interval, 19.3-86.9 months) compared with 10.1 months (95% confidence interval, 6.9-12.4 months) in PDNEC patients (P = 0.0009). Response rate to platinum agents was 10% in G3 WD-panNETs and 37% in PDNEC. Response rate to alkylating agents was 50% in G3 WD-panNETs and 50% in PDNEC.
CONCLUSIONS
Both G3 WD-panNETs and PDNEC responded to platinum and alkylating agents. Overall survival was significantly greater in G3 WD-panNETs compared with PDNEC. These findings challenge current classification and suggest that G3 panNENs should be classified by morphology.
目的
新出现的数据表明，并非所有3级（G3）胰腺神经内分泌肿瘤（panNENs）的行为都相同；肿瘤分化可能预测预后。
方法
确定1999年至2014年在我们机构接受治疗的G3 panNENs患者。确定人口统计学、对治疗的反应和总生存期。
结果
共确定45例患者，其中16例为G3高分化胰腺神经内分泌肿瘤（WD-panNETs），29例为低分化神经内分泌癌（PDNEC）。G3 WD-panNET患者的中位总生存期为52.2个月（95%置信区间，19.3 - 86.9个月），而PDNEC患者为10.1个月（95%置信区间6.9 - 12.4个月）（P = 0.0009）。G3 WD-panNETs对铂类药物的反应率为10%，PDNEC为37%。G3 WD-panNETs对烷化剂的反应率为50%，PDNEC为50%。
结论
G3 WD-panNETs和PDNEC对铂类和烷化剂均有反应。G3 WD-panNETs的总生存期明显长于PDNEC。这些发现挑战了当前的分类，并表明G3 panNENs应按形态学分类。
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