根治性切除术后胰腺和十二指肠神经内分泌肿瘤复发的比较：单中心分析。

Comparison of Recurrence Between Pancreatic and Duodenal Neuroendocrine Neoplasms After Curative Resection: A Single-Institution Analysis.

机构信息

Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan.

Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan.

出版信息

Ann Surg Oncol. 2018 Feb;25(2):528-534. doi: 10.1245/s10434-017-6260-1. Epub 2017 Nov 21.

DOI:10.1245/s10434-017-6260-1

PMID:29164413

Abstract

BACKGROUND

The primary site of a neuroendocrine neoplasms (NEN) around the head of the pancreas is sometimes difficult to assess before resection, and the characteristics of the primary site around this region have not been elucidated for recurrence after curative resection. In this study, the clinicopathologic characteristics of pancreatic NEN (PanNEN) and duodenal NEN (DuNEN) were evaluated, and the risk factors as well as the recurrence types after resection were investigated.

METHODS

Consecutively diagnosed NEN patients at the authors' hospital from January 2000 to July 2016 were evaluated in this study. For 117 PanNEN patients and 31 non-ampullary DuNEN patients, R0 resection was achieved. The median follow-up period was 8.1 years.

RESULTS

In this study, 27 PanNEN patients (23.1%) had recurrences, with a median disease-free survival (DFS) of 133 months, whereas 11 DuNEN patients (35.5%) had recurrences, with a median DFS of 156 months. The PanNEN patients tended to have primary recurrence in the liver (85.2%), followed by lymph nodes (11.1%). The independent risk factors for short DFS were lymph node metastasis at resection (p = 0.001) and microvascular invasion (p = 0.048). In contrast, the DuNEN patients were likely to have lymph node metastasis (81.8%). The independent risk factors for short DFS were lymph node metastasis at resection (p = 0.003) and large diameter (p = 0.013).

CONCLUSIONS

Most initial recurrences of PanNEN occurred in the liver, whereas those of DuNEN appeared in lymph nodes, suggesting that proper diagnosis of the primary site and appropriate imaging methods for surveillance after resection are necessary.

摘要

背景

在胰腺头部周围的神经内分泌肿瘤（NEN）的原发部位有时在切除前难以评估，并且对于根治性切除后的复发，该区域的原发部位的特征尚未阐明。在这项研究中，评估了胰腺神经内分泌肿瘤（PanNEN）和十二指肠神经内分泌肿瘤（DuNEN）的临床病理特征，并研究了切除后的复发危险因素和复发类型。

方法

本研究评估了作者医院 2000 年 1 月至 2016 年 7 月连续诊断的 NEN 患者。对于 117 例 PanNEN 患者和 31 例非壶腹 DuNEN 患者，实现了 R0 切除。中位随访时间为 8.1 年。

结果

在这项研究中，27 例 PanNEN 患者（23.1％）出现复发，中位无病生存（DFS）为 133 个月，而 11 例 DuNEN 患者（35.5％）出现复发，中位 DFS 为 156 个月。PanNEN 患者的原发性复发倾向于发生在肝脏（85.2％），其次是淋巴结（11.1％）。DFS 较短的独立危险因素是切除时淋巴结转移（p=0.001）和微血管侵犯（p=0.048）。相比之下，DuNEN 患者更可能发生淋巴结转移（81.8％）。DFS 较短的独立危险因素是切除时淋巴结转移（p=0.003）和大直径（p=0.013）。