Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Ann Surg Oncol. 2020 Oct;27(10):3915-3923. doi: 10.1245/s10434-020-08497-4. Epub 2020 Apr 23.
Pancreatic neuroendocrine tumors (PNETs) are often indolent; however, identifying patients at risk for rapidly progressing variants is critical, particularly for those with small tumors who may be candidates for expectant management. Specific growth rate (SGR) has been predictive of survival in other malignancies but has not been examined in PNETs.
A retrospective cohort study of adult patients who underwent PNET resection from 2000 to 2016 was performed utilizing the multi-institutional United States Neuroendocrine Study Group database. Patients with ≥ 2 preoperative cross-sectional imaging studies at least 30 days apart were included in our analysis (N = 288). Patients were grouped as "high SGR" or "low SGR." Demographic and clinical factors were compared between the groups. Kaplan-Meier and log-rank analysis were used for survival analysis. Cox proportional hazard analysis was used to assess the impact of various clinical factors on overall survival (OS).
High SGR was associated with higher T stage at resection, shorter doubling time, and elevated HbA1c (all P ≤ 0.01). Patients with high SGR had significantly decreased 5-year OS (63 vs 80%, P = 0.01) and disease-specific survival (72 vs 91%, P = 0.03) compared to those with low SGR. In patients with small (≤ 2 cm) tumors (N = 106), high SGR predicted lower 5-year OS (79 vs 96%, P = 0.01). On multivariate analysis, high SGR was independently associated with worse OS (hazard ratio 2.67, 95% confidence interval 1.05-6.84, P = 0.04).
High SGR is associated with worse survival in PNET patients. Evaluating PNET SGR may enhance clinical decision-making, particularly when weighing expectant management versus surgery in patients with small tumors.
胰腺神经内分泌肿瘤（PNETs）通常发展缓慢；然而，识别具有快速进展变异风险的患者至关重要，特别是对于那些肿瘤较小、可能适合期待治疗的患者。特定生长率（SGR）已被证明对其他恶性肿瘤的生存具有预测性，但尚未在 PNETs 中进行研究。
利用美国神经内分泌研究组的多机构数据库，对 2000 年至 2016 年间接受 PNET 切除术的成年患者进行了回顾性队列研究。我们的分析纳入了至少有 2 次术前横断面成像研究且两次检查至少相隔 30 天的患者（N=288）。患者分为“高 SGR”或“低 SGR”。比较两组之间的人口统计学和临床因素。采用 Kaplan-Meier 和对数秩检验进行生存分析。Cox 比例风险分析用于评估各种临床因素对总生存期（OS）的影响。
高 SGR 与较高的切除时 T 分期、较短的倍增时间和升高的糖化血红蛋白（均 P≤0.01）相关。与低 SGR 患者相比，高 SGR 患者的 5 年 OS（63% vs. 80%，P=0.01）和疾病特异性生存率（72% vs. 91%，P=0.03）显著降低。在肿瘤直径≤2cm（N=106）的患者中，高 SGR 预测较低的 5 年 OS（79% vs. 96%，P=0.01）。多变量分析显示，高 SGR 与较差的 OS 独立相关（风险比 2.67，95%置信区间 1.05-6.84，P=0.04）。
高 SGR 与 PNET 患者的生存较差相关。评估 PNET SGR 可能会增强临床决策，特别是在权衡期待治疗与手术时，对于肿瘤较小的患者。
