Zhou Hao, Wang Yajie, Guo Chuangen, Li Xiaoshuang, Cui Wenjing, Wang Zhongqiu, Chen Xiao
Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Department of Radiology, The First Affiliated Hospital, School of Medical College, Zhejiang University, Hangzhou, China.
Front Oncol. 2021 Feb 25;11:630316. doi: 10.3389/fonc.2021.630316. eCollection 2021.
The role of neural invasion has been reported in cancers. Few studies also showed that neural invasion was related to survival rate in patients with pancreatic neuroendocrine tumor (PNET). The aim of this study is to explore the association between neural invasion and aggressive behaviors in PNET.
After excluding those patients with biopsy and with missing histological data, a total 197 patients with PNET who underwent surgery were retrospectively analyzed. The demographic data and histological data were obtained. Aggressive behavior was defined based on extra-pancreatic extension including vascular invasion, organ invasion and lymph node metastases. Logistic regression analyses were used to identify risk factor for aggressive behavior. Receiver operating characteristic (ROC) curves were performed to show the performance of nomograms in evaluating aggressive behavior of PNET.
The prevalence of neural invasion in the cohort was 10.1% (n = 20). The prevalence of lymph node metastasis, organ invasion, and vascular invasion in PNET patients with neural invasion was higher than those in patients without neural invasion (p < 0.05). Neural invasion was more common in grade 3 (G3) tumors than G1/G2 (p < 0.01). Tumor size, tumor grade, and neural invasion were independent associated factors of aggressive behavior (p < 0.05) after adjusting for possible cofounders in total tumors and G1/G2 tumors. Two nomograms were developed to predict the aggressive behavior. The area under the ROC curve was 0.84 (95% confidence interval (CI): 0.77-0.90) for total population and was 0.84 (95% CI: 0.78-0.89) for patients with G1/G2 PNET respectively.
Neural invasion is associated with aggressive behavior in PNET. Nomograms based on tumor size, grade and neural invasion show acceptable performances in predicting aggressive behavior in PNET.
神经侵犯在癌症中的作用已有报道。少数研究还表明，神经侵犯与胰腺神经内分泌肿瘤（PNET）患者的生存率相关。本研究旨在探讨PNET中神经侵犯与侵袭性行为之间的关联。
排除活检患者及组织学数据缺失的患者后，对197例行手术治疗的PNET患者进行回顾性分析。获取人口统计学数据和组织学数据。侵袭性行为根据胰腺外侵犯来定义，包括血管侵犯、器官侵犯和淋巴结转移。采用逻辑回归分析确定侵袭性行为的危险因素。绘制受试者工作特征（ROC）曲线以显示列线图在评估PNET侵袭性行为方面的性能。
该队列中神经侵犯的发生率为10.1%（n = 20）。有神经侵犯的PNET患者的淋巴结转移、器官侵犯和血管侵犯发生率高于无神经侵犯的患者（p < 0.05）。神经侵犯在3级（G3）肿瘤中比G1/G2肿瘤更常见（p < 0.01）。在调整了总肿瘤和G1/G2肿瘤中可能的混杂因素后，肿瘤大小、肿瘤分级和神经侵犯是侵袭性行为的独立相关因素（p < 0.05）。制定了两个列线图来预测侵袭性行为。总人群的ROC曲线下面积为0.84（95%置信区间（CI）：0.77 - 0.90），G1/G2 PNET患者的ROC曲线下面积分别为0.84（95% CI：0.78 - 0.89）。
神经侵犯与PNET的侵袭性行为相关。基于肿瘤大小、分级和神经侵犯的列线图在预测PNET侵袭性行为方面表现出可接受的性能。
