胰腺神经内分泌肿瘤（Pan-NENs）手术策略的演变：高容量机构 587 例连续切除的时间趋势和结果分析。

The Evolution of Surgical Strategies for Pancreatic Neuroendocrine Tumors (Pan-NENs): Time-trend and Outcome Analysis From 587 Consecutive Resections at a High-volume Institution.

机构信息

General and Pancreatic Surgery Department, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.

Department of Oncology, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.

出版信息

Ann Surg. 2019 Apr;269(4):725-732. doi: 10.1097/SLA.0000000000002594.

DOI:10.1097/SLA.0000000000002594

PMID:29189384

Abstract

OBJECTIVE

The objective of the present analysis is 2-fold: first, to define the evolution of time trends on the surgical approach to pancreatic neuroendocrine neoplasms (Pan-NENs); second, to perform a complete analysis of the predictors of oncologic outcome.

BACKGROUND

Reflecting their rarity and heterogeneity, Pan-NENs represent a clinical dilemma. In particular, there is a scarcity of data regarding their long-term follow-up after surgical resection.

METHODS

From the Institutional Pan-NEN database, 587 resected cases from 1990 to 2015 were extracted. The time span was arbitrarily divided into 3 discrete clusters enabling a balanced comparison between patient groups. Analyses for predictors of recurrence and survival were performed, together with conditional survival analyses.

RESULTS

Among the 587 resected Pan-NENs, 75% were nonfunctioning tumors, and 5% were syndrome-associated tumors. The mean age was 54 years (±14 years), and 51% of the patients were female. The median tumor size was 20 mm (range 4 to 140), 62% were G1, 32% were G2, and 4% were G3 tumors. Time trends analysis revealed that the number of resected Pan-NENs constantly increased, while the size (from 25 to 20 mm) and G1 proportion (from 65% to 49%) decreased during the study period. After a mean follow-up of 75 months, recurrence analysis revealed that nonfunctioning tumors, tumor grade, N1 status, and vascular invasion were all independent predictors of recurrence. Regardless of size, G1 nonfunctioning tumors with no nodal involvement and vascular invasion had a negligible risk of recurrence at 5 years.

CONCLUSIONS

Pan-NENs have been increasingly diagnosed and resected during the last 3 decades, revealing reliable predictors of outcome. Functioning and nodal status, tumor grade, and vascular invasion accurately predict survival and recurrence with resulting implications for patient follow-up.

摘要

目的

本分析的目的有两个：第一，确定胰腺神经内分泌肿瘤（Pan-NENs）手术方式的时间趋势演变；第二，全面分析肿瘤学结果的预测因素。

背景

反映其罕见性和异质性，Pan-NENs 代表了临床难题。特别是，关于手术切除后长期随访的资料很少。

方法

从机构 Pan-NEN 数据库中提取了 1990 年至 2015 年 587 例切除病例。时间跨度被任意分为 3 个离散的时间段，以使患者组之间的平衡比较。进行了复发和生存的预测因素分析，以及条件生存分析。

结果

在 587 例切除的 Pan-NENs 中，75%为无功能肿瘤，5%为综合征相关肿瘤。平均年龄为 54 岁（±14 岁），51%为女性。肿瘤的中位大小为 20mm（范围 4 至 140），62%为 G1，32%为 G2，4%为 G3 肿瘤。时间趋势分析表明，切除的 Pan-NENs 数量不断增加，而肿瘤大小（从 25 至 20mm）和 G1 比例（从 65%至 49%）在研究期间下降。在平均随访 75 个月后，复发分析显示无功能肿瘤、肿瘤分级、N1 状态和血管侵犯均为复发的独立预测因素。无论大小如何，无淋巴结受累和血管侵犯的 G1 无功能肿瘤在 5 年内复发风险可忽略不计。