Department of Hepatobiliary Surgery, Hepatopancreatobiliary (HPB) Surgical Unit, Addenbrooke's Hospital, Cambridge, UK.
Department of Statistics, University of Cambridge, UK.
Pancreatology. 2019 Oct;19(7):1000-1007. doi: 10.1016/j.pan.2019.08.005. Epub 2019 Aug 16.
Non-functional pancreatic neuroendocrine tumours (NF-PNETs) are rare and have highly variable outcomes. Current guidelines recommend surveillance for NF-PNETs <2 cm. Patients who ultimately have surgical resection are at risk of disease recurrence, and data to support postoperative surveillance protocols are lacking. The aims of this study were to i) identify post-operative predictors of recurrence and ii) risk stratify patients at risk of recurrence.
Consecutive patients who underwent surgery for NF-PNETs between 2002 and 2015 were identified retrospectively. Data were collected on demographics, pre-operative laboratory results and histopathological tumour characteristics. Statistical analyses were based on penalised Cox-regression modelling and a decision-tree model. Comparison of the variables identified was performed using ROC curves to identify the most sensitive and specific variable associated with disease recurrence.
We identified 73 patients (38 males) with a median age of 61.5 years (range: 31-79). The median period of follow-up was 49 months (5-131). During follow up, 10 deaths (13.9%) were recorded and disease recurrence occurred in 12 patients (16.4%). The Kaplan-Meier predicted 1-,3- and 5-year recurrence-free survival rates were 98.6% (95% CI = 95.9, 100%), 85.4% (76.9-94.8%) and 72% (58.7-88.2%) respectively. Cox multivariate analysis identified poor tumour differentiation (WHO G3 grade) and lymph node ratio (LNR) as independent predictors for recurrence (p < 0.05). A simple criterion of 'tumour grade G3 or LNR ≥0.1' was found to be sensitive and specific in detecting disease recurrence.
Our results have identified a simple and sensitive criterion for risk stratifying post-resection surveillance. Prospective validation in larger patient cohort is now warranted.
无功能性胰腺神经内分泌肿瘤（NF-PNETs）较为罕见，且其结局具有高度异质性。目前的指南建议对直径＜2cm 的 NF-PNET 进行监测。最终接受手术切除的患者有疾病复发的风险，且缺乏支持术后监测方案的数据。本研究旨在：i）确定术后复发的预测因素；ii）对有复发风险的患者进行风险分层。
回顾性分析 2002 年至 2015 年间行手术治疗的 NF-PNET 连续患者。收集人口统计学、术前实验室检查结果和组织病理学肿瘤特征等数据。统计分析基于惩罚 Cox 回归模型和决策树模型。使用 ROC 曲线比较确定与疾病复发相关的最敏感和最特异的变量。
共纳入 73 例患者（38 例男性），中位年龄为 61.5 岁（范围：31-79）。中位随访时间为 49 个月（5-131）。随访期间，记录到 10 例死亡（13.9%）和 12 例疾病复发（16.4%）。Kaplan-Meier 预测的 1、3 和 5 年无复发生存率分别为 98.6%（95%CI=95.9，100%）、85.4%（76.9-94.8%）和 72%（58.7-88.2%）。Cox 多变量分析发现肿瘤分化不良（WHO G3 级）和淋巴结比值（LNR）是复发的独立预测因素（p＜0.05）。发现“肿瘤分级 G3 或 LNR≥0.1”的简单标准对检测疾病复发具有较高的敏感性和特异性。
本研究结果确定了一种简单而敏感的术后监测风险分层标准。目前需要在更大的患者队列中进行前瞻性验证。
