Department of Hepatobiliary, Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
J Surg Oncol. 2019 Dec;120(8):1302-1310. doi: 10.1002/jso.25753. Epub 2019 Nov 3.
The current study sought to investigate the impact of tumor size and total number of LN examined (TNLE) on the incidence of lymph node metastasis (LNM) among patients with duodenal neuroendocrine tumor (dNET).
Patients who underwent curative resection for dNETs between 1997-2016 were identified from 8 high-volume US centers. Risk factors associated with overall survival and LNM were identified and the optimal cut-off of TNLE relative to LNM was determined.
Among 162 patients who underwent resection of dNETs, median patient age was 59 (interquartile range [IQR], 51-68) years and median tumor size was 1.2 cm (IQR, 0.7-2.0 cm); a total of 101 (62.3%) patients underwent a concomitant LND at the time of surgery. Utilization of lymphadenectomy (LND) increased relative to tumor size (≤1 cm:52.2% vs 1-2 cm:61.4% vs >2 cm:93.8%; P < .05). Similarly, the incidence of LNM increased with dNET size (≤1 cm: 40.0% vs 1-2 cm:65.7% vs >2 cm:80.0%; P < .05). TNLE ≥ 8 had the highest discriminatory power relative to the incidence of LNM (area under the curve = 0.676). On multivariable analysis, while LNM was not associated with prognosis (hazard ratio [HR] = 0.9; 95% confidence intervals [95%CI], 0.4-2.3), G2/G3 tumor grade was (HR = 1.5; 95%CI, 1.0-2.1).
While the incidence of LNM directly correlated with tumor size, patients with dNETs ≤ 1 cm had a 40% incidence of LNM. Regional lymphadenectomy of a least 8 LN was needed to stage patients accurately.
本研究旨在探讨肿瘤大小和检查的淋巴结总数（TNLE）对十二指肠神经内分泌肿瘤（dNET）患者淋巴结转移（LNM）发生率的影响。
从 8 个大容量美国中心确定了 1997 年至 2016 年间接受 dNET 根治性切除术的患者。确定了与总生存率和 LNM 相关的危险因素，并确定了 TNLE 与 LNM 相关的最佳截止值。
在接受 dNET 切除术的 162 名患者中，中位患者年龄为 59 岁（四分位距 [IQR]，51-68 岁），肿瘤大小中位数为 1.2cm（IQR，0.7-2.0cm）；共有 101 名（62.3%）患者在手术时同时进行了淋巴结清扫术（LND）。LND 的使用与肿瘤大小相关（≤1cm：52.2%比 1-2cm：61.4%比>2cm：93.8%；P<0.05）。同样，LNM 的发生率随着 dNET 大小的增加而增加（≤1cm：40.0%比 1-2cm：65.7%比>2cm：80.0%；P<0.05）。TNLE≥8 与 LNM 发生率的相关性具有最高的区分能力（曲线下面积=0.676）。多变量分析显示，尽管 LNM 与预后无关（风险比[HR]=0.9；95%置信区间[95%CI]，0.4-2.3），G2/G3 肿瘤分级与预后相关（HR=1.5；95%CI，1.0-2.1）。
尽管 LNM 的发生率与肿瘤大小直接相关，但 dNETs≤1cm 的患者 LNM 发生率为 40%。需要进行至少 8 个淋巴结的区域淋巴结清扫术以准确分期患者。
