Guo Jingfei, Zhao Jianjun, Bi Xinyu, Li Zhiyu, Huang Zhen, Zhang Yefan, Cai Jianqiang, Zhao Hong
Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Oncotarget. 2017 May 23;8(21):35368-35375. doi: 10.18632/oncotarget.15685.
The incidence of nonfunctioning pancreatic neuroendocrine tumors smaller than 2cm has increased remarkably in the last two decades. Controversies exist regarding whether surgery should be conducted for this group of tumors.
MEDLINE, EMBASE and CENTRAL were search until 2017/01/17. Studies with comparative results between operation and observation group were included. Primary outcomes were overall survival and disease specific survival. Secondary outcomes were disease progression and surgical death and complications.
6 studies with a total of 1861 patients were identified. No randomized controlled trials were found. Survival rate was high (97-100%) and no patients died because of the disease in 5 of the 6 studies, with no difference between operation and observation group. Disease progression was compared in 3 of the 6 studies. 2 studies reported minimal disease progression (0-3.5%) and no significant difference between operation and observation group. Perioperative deaths were rare (0-3%), but complications were common (33-46%). None of the 46 patients who crossed over form observation to operation group had disease recurrence after resection.
Small NF-PNETs without distant metastasis, lymph node metastasis and local invasion on imaging studies can be observed without increase in death and disease progression.
在过去二十年中，直径小于2cm的无功能胰腺神经内分泌肿瘤的发病率显著增加。对于这组肿瘤是否应进行手术治疗存在争议。
检索MEDLINE、EMBASE和CENTRAL数据库至2017年1月17日。纳入手术组与观察组具有比较结果的研究。主要结局为总生存期和疾病特异性生存期。次要结局为疾病进展、手术死亡和并发症。
共纳入6项研究，总计1861例患者。未发现随机对照试验。生存率较高（97 - 100%），6项研究中有5项研究中无患者因疾病死亡，手术组与观察组之间无差异。6项研究中有3项对疾病进展进行了比较。2项研究报告疾病进展轻微（0 - 3.5%），手术组与观察组之间无显著差异。围手术期死亡罕见（0 - 3%），但并发症常见（33 - 46%）。从观察组转为手术组的46例患者中，无一例在切除术后出现疾病复发。
影像学检查未发现远处转移、淋巴结转移和局部侵犯的小无功能胰腺神经内分泌肿瘤可进行观察，而不会增加死亡和疾病进展风险。
