Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
World J Surg. 2021 Jul;45(7):2134-2141. doi: 10.1007/s00268-021-06020-8. Epub 2021 Mar 25.
Patients can experience recurrence following curative-intent resection of non-functional pancreatic neuroendocrine tumors (NF-pNETs). We sought to develop a nomogram to risk stratify patients relative to recurrence following resection of NF-pNETs.
Patients who underwent curative-intent resection for NF-pNETs between 1997 and 2016 were identified from a multi-institutional database. The impact of clinicopathologic factors, including tumor burden score (TBS) (TBS = (maximum tumor diameter) + (number of tumors)), was assessed relative to recurrence-free survival (RFS), and a nomogram was developed and internally validated.
With a median follow-up of 31.0 months (IQR 11.3-56.6 months), 66 (15.8%) out of 416 patients in the cohort experienced tumor recurrence. Overall, 3-, 5-, and 10-year RFS following curative-intent resection was 83.2%, 74.0%, and 44.7%, respectively. Several factors were associated with risk of recurrence including tumor grade (referent G1: G2, HR 4.07, 95% CI 2.29-7.26, p < 0.001; G3, HR 10.83, 95% CI 3.72-31.53, p < 0.001), lymph node metastasis (LNM) (HR 4.71, 95% CI 2.69-8.26, p < 0.001), as well as TBS (referent low: medium, HR 4.36, 95% CI 2.06-9.24, p < 0.001; high, HR 6.04, 95% CI 2.96-12.31, p < 0.001). A weighted nomogram including tumor grade (G1 0, G2 54.19, G3 100), LNM (N0 0, N1 42.06), and TBS (low 0, medium 44.07, high 56.48) was developed. The discriminatory power of the nomogram was very good with a C-index of 0.75 (95% CI, 0.66-0.79) in the training cohort and 0.71 (95% CI, 0.65-0.75) in the validation cohort. In addition, the nomogram performed better than the current 8th edition of AJCC TNM staging system, which had a C-index of 0.67 (95% CI, 0.60-0.73).
A nomogram that incorporated tumor grade, LNM, and TBS was established that had good discrimination and calibration. The nomogram may be an effective tool to stratify patients relative to recurrence risk following resection of NF-pNETs.
在对非功能性胰腺神经内分泌肿瘤（NF-pNETs）进行根治性切除后，患者可能会出现复发。我们试图开发一种列线图，以便对接受 NF-pNET 切除术的患者进行复发风险分层。
从多机构数据库中确定了 1997 年至 2016 年期间接受根治性切除术治疗的 NF-pNET 患者。评估了临床病理因素（包括肿瘤负担评分（TBS）（TBS=（最大肿瘤直径）+（肿瘤数量）））对无复发生存率（RFS）的影响，并开发和内部验证了一个列线图。
在队列中，416 名患者中有 66 名（15.8%）在中位随访 31.0 个月（IQR 11.3-56.6 个月）时出现肿瘤复发。总体而言，根治性切除术后 3、5 和 10 年的 RFS 分别为 83.2%、74.0%和 44.7%。一些因素与复发风险相关，包括肿瘤分级（参考 G1：G2，HR 4.07，95%CI 2.29-7.26，p<0.001；G3，HR 10.83，95%CI 3.72-31.53，p<0.001）、淋巴结转移（LNM）（HR 4.71，95%CI 2.69-8.26，p<0.001）以及 TBS（参考低值：中值，HR 4.36，95%CI 2.06-9.24，p<0.001；高值，HR 6.04，95%CI 2.96-12.31，p<0.001）。开发了一个包含肿瘤分级（G1 0，G2 54.19，G3 100）、LNM（N0 0，N1 42.06）和 TBS（低值 0，中值 44.07，高值 56.48）的加权列线图。该列线图的区分度非常好，在训练队列中的 C 指数为 0.75（95%CI，0.66-0.79），在验证队列中的 C 指数为 0.71（95%CI，0.65-0.75）。此外，该列线图的表现优于当前的第 8 版 AJCC TNM 分期系统，后者的 C 指数为 0.67（95%CI，0.60-0.73）。
建立了一个包含肿瘤分级、LNM 和 TBS 的列线图，该列线图具有良好的区分度和校准度。该列线图可能是一种有效的工具，可用于对接受 NF-pNET 切除术的患者进行复发风险分层。
