Department of Internal MedicineSection Endocrinology, ENETS Centre of Excellence for Neuroendocrine Tumours, Erasmus University Medical Center and Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Department of SurgeryENETS Centre of Excellence for Neuroendocrine Tumours, Erasmus University Medical Center and Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Endocr Relat Cancer. 2018 Mar;25(3):245-254. doi: 10.1530/ERC-17-0282. Epub 2017 Dec 18.
Mesenteric fibrosis (MF) surrounding a mesenteric mass is a hallmark feature of small intestinal neuroendocrine tumours (SI-NETs). Since this can induce intestinal obstruction, oedema and ischaemia, prophylactic resection of the primary tumour and mesenteric mass is often recommended. This study assessed the predictors for mesenteric metastasis and fibrosis and the effect of MF and palliative surgery on survival. A retrospective analysis of 559 patients with pathologically proven SI-NET and available CT-imaging data was performed. Clinical characteristics, presence of mesenteric mass and fibrosis on CT imaging and the effect of palliative abdominal surgery on overall survival were assessed. We found that MF was present in 41.4%. Older age, 5-HIAA excretion ≥67 μmol/24 h, serum CgA ≥121.5 μg/L and a mesenteric mass ≥27.5 mm were independent predictors of MF. In patients ≤52 years, mesenteric mass was less often found in women than in men (39% vs 64%, = 0.002). Corrected for age, tumour grade, CgA and liver metastasis, MF was not a prognostic factor for overall survival. In patients undergoing palliative surgery, metastasectomy of mesenteric mass or prophylactic surgery did not result in survival benefit. In conclusion, we confirmed known predictors of MF and mesenteric mass and suggest a role for sex hormones as women ≤52 years have less often a mesenteric mass. Furthermore, the presence of MF has no effect on survival in a multivariate analysis, and we found no benefit of metastasectomy of mesenteric mass or prophylactic surgery on overall survival.
肠系膜纤维化（MF）环绕肠系膜肿块是小肠神经内分泌肿瘤（SI-NETs）的一个标志特征。由于这可能导致肠梗阻、水肿和缺血，因此通常建议对原发肿瘤和肠系膜肿块进行预防性切除。本研究评估了肠系膜转移和纤维化的预测因素，以及 MF 和姑息性手术对生存的影响。对 559 名经病理证实的 SI-NET 患者进行了回顾性分析，并提供了 CT 成像数据。评估了 CT 成像上肠系膜肿块和纤维化的存在、姑息性腹部手术对总生存的影响以及临床特征、肠系膜肿块和纤维化的存在、姑息性腹部手术对总生存的影响。我们发现 MF 存在于 41.4%的患者中。年龄较大、5-HIAA 排泄量≥67μmol/24h、血清 CgA≥121.5μg/L 和肠系膜肿块≥27.5mm 是 MF 的独立预测因素。在≤52 岁的患者中，女性肠系膜肿块的发生率低于男性（39%比 64%，P=0.002）。校正年龄、肿瘤分级、CgA 和肝转移后，MF 不是总生存的预后因素。在接受姑息性手术的患者中，肠系膜肿块的转移瘤切除术或预防性手术并未带来生存获益。总之，我们证实了已知的 MF 和肠系膜肿块的预测因素，并提示性激素可能起作用，因为≤52 岁的女性肠系膜肿块较少。此外，在多变量分析中 MF 的存在对生存没有影响，我们也没有发现肠系膜肿块的转移瘤切除术或预防性手术对总生存有获益。
