Department of Surgery, ENETS co-E IPC NET Center, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France.
Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France.
World J Surg Oncol. 2020 Aug 15;18(1):208. doi: 10.1186/s12957-020-01994-6.
Pancreatic neuroendocrine tumors (PNET) are rare, with a significant malignant potential. This study aimed to determine outcomes of patients with resected PNETs according to the cystic component and confirm the accuracy of preoperative staging.
From 1997 to 2016, 106 patients underwent resection of PNETs, including 73 purely solid (S-PNETs, 69%), 21 mixed (M-PNETs, 20%), and 12 purely cystic lesions (C-PNETs, 11%). To ensure consistent comparisons of overall (OS) and disease-free (DFS) survival outcomes between the 3 groups, the patients were matched according to the World Health Organization (WHO) grade and tumor height.
Overall, the rate of correlation between the preoperative and pathological diagnoses was low in the C-PNET group (33%, P = 0.03). None of the 24 patients (23%) with metastatic disease at the time of surgery were in the C-PNET group. Furthermore, significantly more parenchyma-sparing resections (P = 0.039) and fewer enlarged resections (P = 0.019) were achieved in the C-PNET group. C-PNET group had a significantly lower node invasion rate than the S-PNET and M-PNET groups (8% vs. 41% and 24%, P = 0.004). Although median OS was comparable in all 3 groups before (P = 0.3) and after (P = 0.18) matching, higher median DFS was observed in the C-PNET group than in the other groups after matching (P = 0.038).
C-PNET was associated with a better prognosis than PNET with a solid component. The results support a wait-and-see policy in cases wherein a reliable preoperative diagnosis remains challenging.
胰腺神经内分泌肿瘤（PNET）较为罕见，具有显著的恶性潜能。本研究旨在根据囊性成分确定接受切除术的 PNET 患者的结局，并确认术前分期的准确性。
1997 年至 2016 年，106 例患者接受了 PNET 切除术，包括 73 例单纯实体（S-PNET，69%）、21 例混合性（M-PNET，20%）和 12 例单纯囊性病变（C-PNET，11%）。为确保 3 组患者的总体（OS）和无病（DFS）生存结局的一致性比较，根据世界卫生组织（WHO）分级和肿瘤高度对患者进行匹配。
总体而言，C-PNET 组术前和术后诊断的相关性较低（33%，P=0.03）。在手术时患有转移性疾病的 24 例患者中无一例属于 C-PNET 组。此外，C-PNET 组实现了更多的实质保留切除术（P=0.039）和更少的扩大切除术（P=0.019）。C-PNET 组的淋巴结侵犯率显著低于 S-PNET 和 M-PNET 组（8%比 41%和 24%，P=0.004）。尽管在匹配前后所有 3 组的中位 OS 均无差异（P=0.3），但在匹配后 C-PNET 组的中位 DFS 高于其他组（P=0.038）。
与实性成分的 PNET 相比，C-PNET 具有更好的预后。这些结果支持在术前诊断仍具挑战性的情况下采取观望政策。
