Yang Min, Ke Neng-Wen, Zhang Yi, Tan Chun-Lu, Tian Bo-Le, Liu Xu-Bao, Huang Wei, Nunes Quentin, Sutton Robert
Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Oncotarget. 2017 Aug 7;8(47):82784-82795. doi: 10.18632/oncotarget.20007. eCollection 2017 Oct 10.
There are currently 2 Tumour-Node-Metastasis (TNM) staging systems for pancreatic neuroendocrine tumours (p-NETs) - European Neuroendocrine Tumour Society (ENETS) and American Joint Committee on Cancer (AJCC). P-NETs being heterogeneous, we investigated the prognostic value of the 2 systems in p-NETs, as a whole, and more interestingly in functional and non-functional sub-groups separately, with a view to ascertaining any potential clinical benefits of using one system over the other.
Data from patients with surgically resected p-NETs were retrospectively reviewed. Kaplan-Meier method and Cox Regression proportional hazards model were used to analyse overall survival (OS) and prognostic predictors respectively.
In the whole group of 165 patients, both TNM systems successfully discriminated OS differences when comparing stages I and II with stages III and IV (<0.05); ENETS stage III patients had a significantly better OS than those in stage IV (=0.003). Patients with functional p-NETs in ENETS stage II showed a statistically better OS than those in stages III and IV (<0.05). For non-functional tumours, the AJCC staging system could effectively discriminate between the OS differences of patients in stage I with stages III and IV, or stage II with III and IV (<0.05). Along with surgical intent and World Health Organisation (WHO) 2010 grade, both ENETS and AJCC staging systems were effective predictors of OS for different function-status p-NETs.
The ENETS system might have potential advantages when applied to all p-NETs and to the functional sub-group, while the AJCC system might be clinically more practical for non-functional p-NETs.
目前有两种用于胰腺神经内分泌肿瘤（p-NETs）的肿瘤-淋巴结-转移（TNM）分期系统，即欧洲神经内分泌肿瘤学会（ENETS）和美国癌症联合委员会（AJCC）。由于p-NETs具有异质性，我们研究了这两种系统对p-NETs整体的预后价值，更有趣的是分别对功能性和非功能性亚组的预后价值，以确定使用一种系统优于另一种系统的任何潜在临床益处。
回顾性分析手术切除的p-NETs患者的数据。分别采用Kaplan-Meier法和Cox回归比例风险模型分析总生存期（OS）和预后预测因素。
在165例患者的整个队列中，当比较I期和II期与III期和IV期时，两种TNM系统均成功区分了OS差异（<0.05）；ENETS III期患者的OS明显优于IV期患者（=0.003）。ENETS II期功能性p-NETs患者的OS在统计学上优于III期和IV期患者（<0.05）。对于非功能性肿瘤，AJCC分期系统可以有效区分I期与III期和IV期患者，或II期与III期和IV期患者的OS差异（<0.05）。与手术意图和世界卫生组织（WHO）2010分级一起，ENETS和AJCC分期系统都是不同功能状态p-NETs患者OS的有效预测因素。
ENETS系统应用于所有p-NETs和功能性亚组时可能具有潜在优势，而AJCC系统对于非功能性p-NETs在临床上可能更实用。
