Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea,
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Neuroendocrinology. 2021;111(8):794-804. doi: 10.1159/000511875. Epub 2020 Oct 1.
The prognostic factors of pancreatic neuroendocrine tumor (PNET) are unclear, and the treatment guidelines are insufficient. This study aimed to suggest a treatment algorithm for PNET based on risk factors for recurrence in a large cohort.
Data of 918 patients who underwent curative intent surgery for PNET were collected from 14 tertiary centers. Risk factors for recurrence and survival analyses were performed.
The 5-year disease-free survival (DFS) rate was 86.5%. Risk factors for recurrence included margin status (R1, hazard ratio [HR] 2.438; R2, HR 3.721), 2010 WHO grade (G2, HR 3.864; G3, HR 7.352), and N category (N1, HR 2.273). A size of 2 cm was significant in the univariate analysis (HR 8.511) but not in the multivariate analysis (p = 0.407). Tumor size was not a risk factor for recurrence, but strongly reflected 2010 WHO grade and lymph node (LN) status. Tumors ≤2 cm had lower 2010 WHO grade, less LN metastasis (p < 0.001), and significantly longer 5-year DFS (77.9 vs. 98.2%, p < 0.001) than tumors >2 cm. The clinicopathologic features of tumors <1 and 1-2 cm were similar. However, the LN metastasis rate was 10.3% in 1-2-cm sized tumors and recurrence occurred in 3.0%. Tumors <1 cm in size did not have any LN metastasis or recurrence.
DISCUSSION/CONCLUSION: Radical surgery is needed in suspected LN metastasis or G3 PNET or tumors >2 cm. Surveillance for <1-cm PNETs should be sufficient. Tumors sized 1-2 cm require limited surgery with LN resection, but should be converted to radical surgery in cases of doubtful margins or LN metastasis.
胰腺神经内分泌肿瘤（PNET）的预后因素尚不清楚，治疗指南也不足。本研究旨在根据大样本中肿瘤复发的危险因素，为 PNET 提出一种治疗方案。
从 14 家三级中心收集了 918 例接受根治性手术治疗的 PNET 患者的数据。进行了复发和生存分析的危险因素。
5 年无病生存率（DFS）为 86.5%。复发的危险因素包括切缘状态（R1，风险比[HR] 2.438；R2，HR 3.721）、2010 年 WHO 分级（G2，HR 3.864；G3，HR 7.352）和 N 分期（N1，HR 2.273）。大小为 2cm 在单因素分析中具有显著性（HR 8.511），但在多因素分析中无显著性（p=0.407）。肿瘤大小不是复发的危险因素，但强烈反映了 2010 年 WHO 分级和淋巴结（LN）状态。肿瘤大小≤2cm 的患者 2010 年 WHO 分级较低，LN 转移较少（p<0.001），5 年 DFS 明显较长（77.9% vs. 98.2%，p<0.001），大于 2cm 的患者。肿瘤大小≤1cm 和 1-2cm 的肿瘤临床病理特征相似。然而，1-2cm 大小的肿瘤 LN 转移率为 10.3%，复发率为 3.0%。肿瘤大小<1cm 的肿瘤无 LN 转移或复发。
讨论/结论：疑似 LN 转移或 G3 PNET 或肿瘤>2cm 时需要根治性手术。<1cm 的 PNET 应进行充分监测。肿瘤大小为 1-2cm 时需要进行有限的手术和 LN 切除，但在切缘可疑或 LN 转移时应转为根治性手术。
