Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Department of Radiology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
J Gastroenterol. 2017 Oct;52(10):1140-1146. doi: 10.1007/s00535-017-1349-7. Epub 2017 May 9.
A novel morphological classification using resected specimens predicted malignant potential and prognosis in patients with pancreatic neuroendocrine tumors (P-NETs). The aim of this study was to examine the predictive ability of morphological diagnoses made using non-invasive multi-detector computed tomography (MDCT) in P-NETs.
Between 2002 and 2015, 154 patients were diagnosed with P-NETs at the Tokyo Medical and Dental University, and 82 patients who underwent surgical treatment were enrolled. The primary tumors were classified by MDCT into three types: Type I, simple nodular tumor; Type II, simple nodular tumor with extra-nodular growth; and Type III, confluent multinodular tumor. Patients were stratified by 15 clinical specialists according to classification and without any other clinical or pathological information. Clinicopathological features and patient survival were reviewed retrospectively.
The mean observation time was 1004 days. Forty-six, 22, and 14 patients had Type I, II, and III tumors, respectively. Morphological classification was significantly correlated with advanced features such as tumor size, Ki-67 index, and synchronous liver metastasis (p < 0.001 for all). There were significant differences between all three tumor types as judged by ENETS TNM classification (p < 0.001), AJCC TNM classification (p = 0.046), WHO 2004 classification (p < 0.001), and WHO 2010 classification (p < 0.001). Five-year progression-free survival (PFS) rates for patients with Type I, II, and III tumors were 97, 43, and 31%, respectively (I vs. II, p < 0.001; I vs. III, p < 0.001; II vs. III, p = 0.017). Multivariate analysis revealed Type II/III tumors and synchronous liver metastasis to be independent risk factors for poor PFS.
A novel simple morphological classification system would predict Type II and III tumors that may have higher malignant potential than Type I tumors.
一种基于切除标本的新型形态学分类方法预测了胰腺神经内分泌肿瘤（P-NETs）患者的恶性潜能和预后。本研究旨在探讨非侵入性多排螺旋 CT（MDCT）在 P-NETs 中的形态学诊断的预测能力。
2002 年至 2015 年，东京医科齿科大学诊断出 154 例 P-NET 患者，其中 82 例行手术治疗。采用 MDCT 将原发肿瘤分为三型：I 型，单纯结节性肿瘤；II 型，单纯结节性肿瘤伴外生结节生长；III 型，融合性多结节性肿瘤。15 位临床专家根据分类对患者进行分层，不考虑任何其他临床或病理信息。回顾性回顾了临床病理特征和患者生存情况。
平均观察时间为 1004 天。46、22 和 14 例患者分别具有 I、II 和 III 型肿瘤。形态学分类与肿瘤大小、Ki-67 指数和同步肝转移等晚期特征显著相关（均 p<0.001）。根据 ENETS TNM 分类（p<0.001）、AJCC TNM 分类（p=0.046）、WHO 2004 分类（p<0.001）和 WHO 2010 分类（p<0.001），所有三种肿瘤类型之间均存在显著差异。I 型、II 型和 III 型肿瘤患者的 5 年无进展生存率（PFS）分别为 97%、43%和 31%（I 型与 II 型，p<0.001；I 型与 III 型，p<0.001；II 型与 III 型，p=0.017）。多变量分析显示，II/III 型肿瘤和同步肝转移是 PFS 不良的独立危险因素。
一种新的简单形态学分类系统可预测恶性潜能可能高于 I 型肿瘤的 II 型和 III 型肿瘤。
