Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy.
University Centre for Statistics in the Biomedical Sciences, "Vita-Salute" University, Milan, Italy.
Dig Liver Dis. 2019 May;51(5):735-740. doi: 10.1016/j.dld.2019.01.008. Epub 2019 Jan 22.
Concerns exist about a conservative management of well-differentiated nonfunctioning small pancreatic neuroendocrine tumors (NF-PanNET) in young patients and when preoperative Ki67 proliferative index is ≥3%.
To evaluate an association between age, tumor size and grading in patients with sporadic NF-PanNET who underwent curative resection.
Patients who underwent surgery for sporadic NF-PanNET (excluding G3) were retrospectively analyzed. Linear regression analysis was performed to evaluate a possible correlation between continuous variables, whereas multiple logistic regression analysis was performed for determining predictors of NF-PanNET-G2.
Overall, 235 patients with NF-PanNET-G1/G2 were included. The median largest radiological diameter was 25 mm. Age correlated neither with tumor size (P = 0.675) nor with Ki67 index (P = 0.376). On multivariate linear regression analysis, factors independently associated with Ki67 index were NF-PanNET size (P = 0.031), perineural invasion (P = 0.004), microvascular invasion (P = 0.001) and necrosis (P = 0.009). The most accurate NF-PanNET size for predicting NF-PanNET-G2 was 25 mm. On multivariate analysis, a NF-PanNET size >25 mm was independently associated with the risk of having a PanNET-G2 (P = 0.025).
No correlations exist between age and NF-PanNET size or proliferative index. Therefore, an a priori aggressive attitude is not justified in young patients with small NF-PanNET, as a long-life expectancy is probably unlikely to increase the risk of malignant transformation.
对于年轻患者和术前 Ki67 增殖指数≥3%的分化良好的非功能性胰腺神经内分泌肿瘤（NF-PanNET），存在保守治疗的担忧。
评估行根治性切除术的散发性 NF-PanNET 患者的年龄、肿瘤大小和分级之间的关系。
回顾性分析接受手术治疗的散发性 NF-PanNET（不包括 G3）患者。进行线性回归分析以评估连续变量之间的可能相关性，而进行多变量逻辑回归分析以确定 NF-PanNET-G2 的预测因素。
共纳入 235 例 NF-PanNET-G1/G2 患者。最大影像学直径的中位数为 25mm。年龄与肿瘤大小（P=0.675）和 Ki67 指数（P=0.376）均无相关性。多变量线性回归分析显示，与 Ki67 指数独立相关的因素包括 NF-PanNET 大小（P=0.031）、神经周围侵犯（P=0.004）、微血管侵犯（P=0.001）和坏死（P=0.009）。预测 NF-PanNET-G2 的最准确 NF-PanNET 大小为 25mm。多变量分析显示，NF-PanNET 大小＞25mm 与发生 PanNET-G2 的风险独立相关（P=0.025）。
年龄与 NF-PanNET 大小或增殖指数之间无相关性。因此，对于年轻的小 NF-PanNET 患者，没有理由预先采取激进的态度，因为预期寿命较长不太可能增加恶性转化的风险。
