Department of Surgery, City of Hope National Medical Center, Duarte, California, USA.
Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California, USA.
Neuroendocrinology. 2020;110(5):384-392. doi: 10.1159/000502581. Epub 2019 Aug 9.
Pancreatic neuroendocrine tumors (p-NETS) are increasing in incidence, and prognostic factors continue to evolve. The benefit of lymphadenectomy for p-NETS ≤2 cm remains unclear. We sought to determine the significance of lymphovascular invasion (LVI) for small p-NETS.
The National Cancer Database was queried for patients with p-NETS ≤2 cm and with ≥1 evaluated lymph node (LN), years 2004-2015. Demographic, clinical, and treatment characteristics were analyzed. Multivariate logistic regression was performed to identify predictors of LN positivity.
Among 2,499 patients identified, tumor location was delineated as the head (26%), body (18%), tail (38%), or unspecified (18%); 74% were well-differentiated versus 10% moderate, 2% poor, and 14% unknown. LVI occurred in 11%. A median of 9 LNs were evaluated; overall positivity was 18%. Mean survival was significantly longer in node-negative patients (115 vs. 95 months, log-rank p < 0.0001). LVI was the strongest predictor of node involvement (OR 10.4, p < 0.0001) when controlling for tumor size, grade, and location. Subset analysis of patients with known LVI status, grade, location, and mitoses found that LVI was more likely in the setting of moderate-to-high tumor grade, 1-2 cm size, pancreatic head location, and high mitotic rate. Among patients with ≥2 of these 4 factors, 25% were node-positive.
Presence of LVI was the strongest predictor of node positivity. LVI on endoscopic biopsy should prompt resection and regional LN dissection to fully stage patients with small p-NETS. Patients with other high-risk factors should also be considered for resection and regional lymphadenectomy.
胰腺神经内分泌肿瘤（p-NETs）的发病率不断增加，预后因素也在不断发展。对于直径≤2cm 的 p-NETs 行淋巴结清扫术的获益仍不明确。我们旨在确定淋巴血管侵犯（LVI）对小直径 p-NETs 的意义。
本研究通过 2004 年至 2015 年国家癌症数据库，检索了直径≤2cm 且至少有 1 枚评估淋巴结的 p-NETs 患者。分析了患者的人口统计学、临床和治疗特征。采用多因素逻辑回归分析确定淋巴结阳性的预测因素。
在确定的 2499 例患者中，肿瘤位置位于胰头（26%）、胰体（18%）、胰尾（38%）或未特指（18%）；74%的肿瘤为高分化，10%为中分化，2%为低分化，14%为未知分化。11%的患者存在 LVI。中位评估淋巴结数为 9 枚；总体淋巴结阳性率为 18%。无淋巴结转移患者的中位生存期显著更长（115 个月 vs. 95 个月，log-rank p < 0.0001）。在控制肿瘤大小、分级和位置后，LVI 是淋巴结受累的最强预测因素（OR 10.4，p < 0.0001）。在已知 LVI 状态、分级、位置和有丝分裂率的患者亚组分析中，LVI 更可能发生于中-高分级肿瘤、1-2cm 大小、胰头位置和高有丝分裂率的情况下。在≥4 个这些因素中的 2 个的患者中，有 25%的患者淋巴结阳性。
LVI 的存在是淋巴结阳性的最强预测因素。内镜活检中存在 LVI 时应行肿瘤切除和区域淋巴结清扫，以充分分期直径较小的 p-NETs。其他高危因素的患者也应考虑进行肿瘤切除和区域淋巴结清扫。
