Yang Min, Zeng Lin, Yao Wen-Qing, Ke Neng-Wen, Tan Chun-Lu, Tian Bo-le, Liu Xu-Bao, Xiang Bo, Zhang Yi
Department of Pediatric Surgery.
President & Dean's Office.
Medicine (Baltimore). 2020 Nov 13;99(46):e22291. doi: 10.1097/MD.0000000000022291.
Histologically, the World Health Organization has classified pancreatic neuroendocrine neoplasms (p-NENs) into well-differentiated pancreatic neuroendocrine tumors (G1/G2 p-NETs) and poorly-differentiated pancreatic neuroendocrine carcinoma (G3 p-NECs) based on tumor mitotic counts and Ki-67 index. Recently, the 8th edition of American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging manual has incorporated some major changes in 2017 that the TNM staging system for p-NENs should only be applied to well-differentiated G1/G2 p-NETs, while poorly-differentiated G3 p-NECs be classified according to the new system for pancreatic exocrine adenocarcinomas. However, this new manual for p-NENs has seldom been evaluated.Data of patients with both G1/G2 and G3 non-functional p-NENs (NF-p-NENs) from our institution was retrospectively collected and analyzed using 2 new AJCC 8th staging systems. We also made survival comparisons between the 8th and 7th edition system separately for different subgroups.For G1/G2 NF-p-NETs, there were 52 patients classified in AJCC 8th edition stage I, 40 in stage II, 41 in stage III and 19 in stage IV. As for G3 NF-p-NECs, 17, 19, 24, and 18 patients were respectively defined from AJCC 8th edition stage I to stage IV. In terms of the AJCC 7th staging system, the 230 patients with NF-p-NENs were totally distributed from stage I to stage IV (94, 63, 36, 37, respectively). For the survival analysis of both G1/G2 NF-p-NETs and G3 NF-p-NECs, the AJCC 7th edition system failed to discriminate the survival differences when compared stage III with stage II or stage IV (P > .05), while the 8th edition ones could perfectly allocate patients into 4 statistically different groups (P < .05). The HCIs of AJCC 8th stage for G1/G2 NF-p-NETs [HCI=0.658, 95% confidence interval (CI)=0.602-0.741] and stage for G3 NF-p-NECs (HCI=0.704, 95% CI=0.595-0.813) was both statistically larger than those of AJCC 7th stage for different grading NF-p-NENs [(HCI=0.578, 95% CI=0.557-0.649; P=.031), (HCI=0.546, 95% CI=0.531-0.636; P = .019); respectively], indicating a more accurate predictive ability for the survivals of NF-p-NENs.Our data suggested the 2 new AJCC 8th staging systems were superior to its 7th edition for patients with both G1/G2 NF-p-NETs and G3 NF-p-NECs.
在组织学上，世界卫生组织已根据肿瘤有丝分裂计数和Ki-67指数将胰腺神经内分泌肿瘤（p-NENs）分为高分化胰腺神经内分泌肿瘤（G1/G2 p-NETs）和低分化胰腺神经内分泌癌（G3 p-NECs）。最近，美国癌症联合委员会（AJCC）第8版肿瘤-淋巴结-转移（TNM）分期手册在2017年纳入了一些重大变化，即p-NENs的TNM分期系统仅适用于高分化G1/G2 p-NETs，而低分化G3 p-NECs应根据胰腺外分泌腺癌的新系统进行分类。然而，这本关于p-NENs的新手册很少得到评估。我们回顾性收集并分析了本机构G1/G2和G3非功能性p-NENs（NF-p-NENs）患者的数据，采用了2种新的AJCC第8版分期系统。我们还分别对不同亚组在第8版和第7版系统之间进行了生存比较。
对于G1/G2 NF-p-NETs，AJCC第8版分期中I期有52例患者，II期有40例，III期有41例，IV期有19例。至于G3 NF-p-NECs，AJCC第8版分期中I期至IV期分别有17、19、24和18例患者。在AJCC第7版分期系统中，230例NF-p-NENs患者从I期到IV期均有分布（分别为94、63、36、37例）。对于G1/G2 NF-p-NETs和G3 NF-p-NECs的生存分析，AJCC第7版系统在比较III期与II期或IV期时未能区分生存差异（P>0.05），而第8版系统能够完美地将患者分为4个具有统计学差异的组（P<0.05）。AJCC第8版G1/G2 NF-p-NETs分期的Harrell一致性指数（HCI）[HCI=0.658，95%置信区间（CI）=0.602-0.741]和G3 NF-p-NECs分期的HCI（HCI=0.704，95% CI=0.595-0.813）在统计学上均高于AJCC第7版不同分级NF-p-NENs分期的HCI[（HCI=0.578，95% CI=0.557-0.649；P=0.031），（HCI=0.546，95% CI=0.531-0.636；P=0.019）；分别]，表明对NF-p-NENs生存的预测能力更准确。
我们的数据表明，对于G1/G2 NF-p-NETs和G3 NF-p-NECs患者，AJCC第8版的2种新分期系统优于第7版。
