Paik Woo Hyun, Lee Hee Seung, Lee Kyong Joo, Jang Sung Ill, Lee Woo Jin, Hwang Jin-Hyeok, Cho Chang Min, Park Chang-Hwan, Han Jimin, Woo Sang Myung, Jeong Seok, Chon Hyung Ku, Kim Tae Nyeun, Lee Jun Kyu, Han Joung-Ho, Yoon Jai Hoon, Kim Yong-Tae, Cho Jae Hee
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Pancreatology. 2021 Jan;21(1):208-214. doi: 10.1016/j.pan.2020.11.016. Epub 2020 Dec 1.
Pancreatic neuroendocrine neoplasms (PNENs) show heterogeneous biological behavior, and most small PNENs show indolent features. Consequently, selected cases can be considered for observation only, according to the National Comprehensive Cancer Network guideline, however, supporting clinical evidence is lacking. We investigated the clinical course of small PNENs and their risk factors for malignant potential.
A total of 158 patients with small pathologically confirmed PNENs ≤2 cm in initial imaging were retrospectively enrolled from 14 institutions. The primary outcome was any metastasis or recurrence event during follow-up.
The median age was 57 years (range, 22-82 years), and 86 patients (54%) were female. The median tumor size at initial diagnosis was 13 mm (range, 7-20 mm). PNENs were pathologically confirmed by surgery in 137 patients and by EUS-guided fine needle aspiration biopsy (EUS-FNAB) in 21 patients. Eight patients underwent EUS-FNAB followed by surgical resection. The results of WHO grade were available in 150 patients, and revealed 123 grade 1, 25 grade 2, and 2 neuroendocrine carcinomas. A total of 145 patients (92%) underwent surgical resection, and three patients had regional lymph node metastasis. During the entire follow-up of median 45.6 months, 11 metastases or recurrences (7%) occurred. WHO grade 2 (HR 13.97, 95% CI 2.60-75.03, p = 0.002) was the only predictive factor for malignant potential in multivariable analysis.
WHO grade is responsible for the malignant potential of small PNENs ≤2 cm. Thus, EUS-FNAB could be recommended in order to provide early treatment strategies of small PNENs.
胰腺神经内分泌肿瘤（PNENs）具有异质性生物学行为，大多数小的PNENs表现为惰性特征。因此，根据美国国立综合癌症网络指南，部分病例仅可考虑进行观察，然而，目前尚缺乏支持性临床证据。我们研究了小PNENs的临床病程及其恶性潜能的危险因素。
从14家机构回顾性纳入158例经病理证实的初始影像学检查显示直径≤2 cm的小PNENs患者。主要结局为随访期间的任何转移或复发事件。
中位年龄为57岁（范围22 - 82岁），86例患者（54%）为女性。初始诊断时肿瘤中位大小为13 mm（范围7 - 20 mm）。137例患者经手术病理确诊为PNENs，21例患者经超声内镜引导下细针穿刺活检（EUS - FNAB）确诊。8例患者先接受EUS - FNAB，随后进行手术切除。150例患者可获得世界卫生组织（WHO）分级结果，其中123例为1级，25例为2级，2例为神经内分泌癌。共有145例患者（92%）接受了手术切除，3例患者出现区域淋巴结转移。在中位45.6个月的整个随访期间，发生了11例转移或复发（7%）。在多变量分析中，WHO 2级（风险比13.97，95%置信区间2.60 - 75.03，p = 0.002）是恶性潜能的唯一预测因素。
WHO分级决定了直径≤2 cm的小PNENs的恶性潜能。因此，推荐进行EUS - FNAB以提供小PNENs的早期治疗策略。
