Luo Guopei, Jin Kaizhou, Cheng He, Guo Meng, Lu Yu, Wang Zhengshi, Yang Chao, Xu Jinzhi, Gao Heli, Zhang Shirong, Zhang Bo, Long Jiang, Xu Jin, Ni Quanxing, Liu Chen, Yu Xianjun
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.
Pancreatology. 2017 Jul-Aug;17(4):599-604. doi: 10.1016/j.pan.2017.06.003. Epub 2017 Jun 10.
Previously we have proposed a modified European Neuroendocrine Tumor Society (mENETS) staging system for pNETs, which is more suitable than either the American Joint Committee on Cancer (AJCC) or the European Neuroendocrine Tumor Society (ENETS) systems. However, it is necessary to revise the nodal stage of the mENETS system for the under representation of stage III diseases.
Nodal substages of the upper gastrointestinal organs (N0: 0 node, N1: 1-2 nodes; N2: ≥3 nodes) or the lower gastrointestinal organs (0: 0 node, N1: 1-3 nodes, and N2:≥ 4 nodes) were incorporated into the mENETS system and evaluated using the Surveillance, Epidemiology, and End Results (SEER) registry series.
The mENETS classification with the upper gastrointestinal N-stage revision (stage III, 17.1%) had better proportional distribution than the mENETS classification (stage III, 8.7%) or the lower gastrointestinal N-stage revision (stage III, 14.5%). N-stage revision (N0: 0 node, N1: 1-2 nodes; N2: ≥3 nodes) was incorporated in the mENETS staging definition for further analysis. Survival curves were well separated by nodal substages. HRs of stage IIA (T3N0M0) and IIB (T1-3N1M0) of the mENETS classification with N-stage revision were similar, indicating these two substages should be attributed to stage II. Survival curves were well separated by stage using the mENETS classification with N-stage revision.
The mENETS classification with N-stage revision (N0: 0 node, N1: 1-2 nodes; N2: ≥3 nodes) had better prognostic value and proportional distribution than the mENETS classification for pNETs and can be used in clinical practice.
此前我们提出了一种用于胰腺神经内分泌肿瘤（pNETs）的改良欧洲神经内分泌肿瘤学会（mENETS）分期系统，该系统比美国癌症联合委员会（AJCC）或欧洲神经内分泌肿瘤学会（ENETS）系统更适用。然而，由于III期疾病的代表性不足，有必要对mENETS系统的淋巴结分期进行修订。
将上消化道器官（N0：0枚淋巴结，N1：1 - 2枚淋巴结；N2：≥3枚淋巴结）或下消化道器官（N0：0枚淋巴结，N1：1 - 3枚淋巴结，N2：≥4枚淋巴结）的淋巴结亚分期纳入mENETS系统，并使用监测、流行病学和最终结果（SEER）登记系列进行评估。
对上消化道N分期进行修订后的mENETS分类（III期，17.1%）比mENETS分类（III期，8.7%）或下消化道N分期修订（III期，14.5%）具有更好的比例分布。将N分期修订（N0：0枚淋巴结，N1：1 - 2枚淋巴结；N2：≥3枚淋巴结）纳入mENETS分期定义以进行进一步分析。生存曲线按淋巴结亚分期能很好地分开。修订N分期后的mENETS分类中IIA期（T3N0M0）和IIB期（T1 - 3N1M0）的风险比相似，表明这两个亚分期应归为II期。使用修订N分期后的mENETS分类，生存曲线按分期能很好地分开。
修订N分期（N0：0枚淋巴结，N1：1 - 2枚淋巴结；N2：≥3枚淋巴结）后的mENETS分类比mENETS分类对pNETs具有更好的预后价值和比例分布，可用于临床实践。
