Fathi Amir H, Romanyshyn Jonathan, Barati Mehdi, Choudhury Uzair, Chen Allen, Sosa Julie Ann
8785 Department of Surgery, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA.
University of Southern Mississippi, Hattiesburg, MS, USA.
Am Surg. 2020 May;86(5):458-466. doi: 10.1177/0003134820919730.
Nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors with continued controversies in management. This study aims to identify demographic and clinicopathologic characteristics associated with aggressive behavior and survival.
The Surveillance, Epidemiology, and End Results database was used to identify patients with NF-PNETs from 1988 to 2012. Multivariate regression analysis and Cox proportional hazards modeling were used to assess the impact of patient, tumor, and treatment characteristics on tumor behavior and overall survival.
In 1787 patients identified, size was a major determinant of aggressive behavior. The probability of aggressiveness increased 100% for tumor size ≥2 cm. For tumors ≥2 cm, every 1-cm increase in size was associated with an increase in probability of aggressive behavior by 11.3%. Patient age, tumor grade, and surgical resection were independent predictors of survival. Surgical resection was associated with improved survival but not grade I or II tumors with size <2 cm.
Patient age, tumor size, and grade should be in the decision-making process around the surgical management of NF-PNETs. For tumors ≤2 cm with histologic grades of I or II, the probability of aggressive behavior is low, and surgical resection does not appear to afford survival benefit. Therefore, close observation could be justified.
无功能性胰腺神经内分泌肿瘤（NF-PNETs）是一种罕见肿瘤，其治疗仍存在争议。本研究旨在确定与侵袭性行为和生存相关的人口统计学及临床病理特征。
利用监测、流行病学和最终结果数据库，确定1988年至2012年期间患有NF-PNETs的患者。采用多变量回归分析和Cox比例风险模型，评估患者、肿瘤和治疗特征对肿瘤行为和总生存的影响。
在1787例确诊患者中，肿瘤大小是侵袭性行为的主要决定因素。肿瘤大小≥2 cm时，侵袭性概率增加100%。对于≥2 cm的肿瘤，每增加1 cm大小，侵袭性行为概率增加11.3%。患者年龄、肿瘤分级和手术切除是生存的独立预测因素。手术切除与生存改善相关，但对于大小<2 cm的I级或II级肿瘤则不然。
在NF-PNETs手术治疗的决策过程中，应考虑患者年龄、肿瘤大小和分级。对于组织学分级为I级或II级且大小≤2 cm的肿瘤，侵袭性行为概率较低，手术切除似乎无法带来生存获益。因此，密切观察是合理的。
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