He Chao-Bin, Zhang Yu, Cai Zhi-Yuan, Lin Xiao-Jun
Department of Hepatobiliary and Pancreatic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
Endocr Connect. 2019 Mar 1;8(3):239-251. doi: 10.1530/EC-18-0485.
Aim The role of surgery in the treatment of metastatic pancreatic neuroendocrine tumors (PNETs) was controversial. The objectives of this study were to illustrate the impact of surgery in improving the prognosis of patients with metastatic PNETs and build nomograms to predict overall survival (OS) and cancer-specific survival (CSS) based on a large population-based cohort. Methods Patients diagnosed with metastatic PNETs between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively collected. Nomograms for estimating OS and CSS were established based on Cox regression model and Fine and Grey's model. The precision of the nomograms was evaluated and compared using concordance index (C-index) and the area under receiver operating characteristic (ROC) curve (AUC). Results The study cohort included 1966 patients with metastatic PNETs. It was shown that the surgery provided survival benefit for all groups of patients with metastatic PNETs. In the whole study cohort, 1-, 2- and 3-year OS and CSS were 51.5, 37.1 and 29.4% and 53.0, 38.9 and 31.1%, respectively. The established nomograms were well calibrated, and had good discriminative ability, with C-indexes of 0.773 for OS prediction and 0.774 for CSS prediction. Conclusions Patients with metastatic PNETs could benefit from surgery when the surgery tolerance was acceptable. The established nomograms could stratify patients who were categorized as tumor-node-metastasis (TNM) IV stage into groups with diverse prognoses, showing better discrimination and calibration of the established nomograms, compared with 8th TNM stage system in predicting OS and CSS for patients with metastatic PNETs.
目的 手术在转移性胰腺神经内分泌肿瘤（PNETs）治疗中的作用存在争议。本研究的目的是阐明手术对改善转移性PNETs患者预后的影响，并基于一个大型人群队列构建列线图以预测总生存期（OS）和癌症特异性生存期（CSS）。方法 回顾性收集2004年至2015年期间来自监测、流行病学和最终结果（SEER）数据库中诊断为转移性PNETs的患者。基于Cox回归模型和Fine及Grey模型建立了估计OS和CSS的列线图。使用一致性指数（C指数）和受试者操作特征曲线（ROC）下面积（AUC）评估并比较列线图的精度。结果 研究队列包括1966例转移性PNETs患者。结果显示，手术为所有转移性PNETs患者组带来了生存益处。在整个研究队列中，1年、2年和3年的OS和CSS分别为51.5%、37.1%和29.4%以及53.0%、38.9%和31.1%。所建立的列线图校准良好，具有良好的判别能力，OS预测的C指数为0.773，CSS预测的C指数为0.774。结论 当手术耐受性可接受时，转移性PNETs患者可从手术中获益。所建立的列线图可将被归类为肿瘤-淋巴结-转移（TNM）IV期的患者分层为具有不同预后的组，与第八版TNM分期系统相比，在预测转移性PNETs患者的OS和CSS方面，所建立的列线图显示出更好的判别能力和校准效果。
