Altimari Marc, Abad John, Chawla Akhil
Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Winfield, IL, USA.
Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Winfield, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
HPB (Oxford). 2021 Oct;23(10):1533-1540. doi: 10.1016/j.hpb.2021.03.005. Epub 2021 Mar 19.
Surgical management of small pancreatic neuroendocrine tumors (PNETs) is variable. Patients may undergo formal oncologic resection, encompassing regional lymphadenectomy, or enucleation. This study's aim was to understand if enucleation is adequate treatment for PNETs <2 cm METHODS: The US National Cancer Database (NCDB) from 2004 to 2016 was used to identify patients who underwent oncologic resection or enucleation for PNETs <2 cm. Fisher's exact test, log-rank, and logistic regression were used.
Of 4083 patients, 75.6% underwent oncologic resection with a median (range) number of 8 (0-99) lymph nodes examined, and 24.1% underwent enucleation. Five-year overall survival rate was 89.7% in node-negative patients versus 82.1% in node-positive patients (p < 0.001). No survival difference existed between patients who underwent enucleation versus oncologic resection (5-yr OS of 88.5% vs 88.2%, p = 0.064). According to AJCC classification, 3776 patients were clinically-staged with evidence of node-negative disease. Of these, 75.1% underwent oncologic resection, of which 9.9% had node-positive disease after resection. Tumor grade and size independently predicted nodal upstaging after oncologic resection.
One-tenth of patients with clinically node-negative disease were node-positive after surgery. Although this was not reflected in overall survival, patients who receive enucleation with higher grade and larger size may benefit from enhanced surveillance for locoregional recurrence.
小胰腺神经内分泌肿瘤（PNETs）的手术管理方式多样。患者可能接受包括区域淋巴结清扫的正规肿瘤切除手术，或肿瘤剜除术。本研究的目的是了解对于直径<2 cm的PNETs，肿瘤剜除术是否为充分的治疗方法。方法：使用2004年至2016年的美国国家癌症数据库（NCDB）来识别因直径<2 cm的PNETs而接受肿瘤切除手术或肿瘤剜除术的患者。采用Fisher精确检验、对数秩检验和逻辑回归分析。
在4083例患者中，75.6%接受了肿瘤切除手术，中位（范围）检查淋巴结数量为8个（0 - 99个），24.1%接受了肿瘤剜除术。无淋巴结转移患者的5年总生存率为89.7%，有淋巴结转移患者为82.1%（p < 0.001）。接受肿瘤剜除术与肿瘤切除手术的患者之间无生存差异（5年总生存率分别为88.5%和88.2%，p = 0.064）。根据美国癌症联合委员会（AJCC）分类，3776例患者经临床分期显示无淋巴结转移证据。其中，75.1%接受了肿瘤切除手术，其中9.9%在切除术后出现淋巴结转移。肿瘤分级和大小可独立预测肿瘤切除术后的淋巴结分期上调。
临床无淋巴结转移疾病的患者中有十分之一在手术后出现淋巴结转移。虽然这在总生存率中未体现，但接受肿瘤剜除术且肿瘤分级较高、体积较大的患者可能受益于加强对局部区域复发的监测。
