识别胰腺神经内分泌肿瘤早期复发的风险因素和模式：一项多机构研究
Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study.
作者信息
Heidsma Charlotte M, Tsilimigras Diamantis I, Rocha Flavio, Abbott Daniel E, Fields Ryan, Poultsides George A, Cho Clifford S, Lopez-Aguiar Alexandra G, Kanji Zaheer, Fisher Alexander V, Krasnick Bradley A, Idrees Kamran, Makris Eleftherios, Beems Megan, van Eijck Casper H J, Nieveen van Dijkum Elisabeth J M, Maithel Shishir K, Pawlik Timothy M
机构信息
Department of Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, USA.
Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
出版信息
Cancers (Basel). 2021 May 7;13(9):2242. doi: 10.3390/cancers13092242.
BACKGROUND
Identifying patients at risk for early recurrence (ER) following resection for pancreatic neuroendocrine tumors (pNETs) might help to tailor adjuvant therapies and surveillance intensity in the post-operative setting.
METHODS
Patients undergoing surgical resection for pNETs between 1998-2018 were identified using a multi-institutional database. Using a minimum -value approach, optimal cut-off value of recurrence-free survival (RFS) was determined based on the difference in post-recurrence survival (PRS). Risk factors for early recurrence were identified.
RESULTS
Among 807 patients who underwent curative-intent resection for pNETs, the optimal length of RFS to define ER was identified at 18 months (lowest -value of 0.019). Median RFS was 11.0 months (95% 8.5-12.60) among ER patients ( = 49) versus 41.0 months (95% CI: 35.0-45.9) among non-ER patients ( = 77). Median PRS was worse among ER patients compared with non-ER patients (42.6 months vs. 81.5 months, = 0.04). On multivariable analysis, tumor size (OR: 1.20, 95% CI: 1.05-1.37, = 0.007) and positive lymph nodes (OR: 4.69, 95% CI: 1.41-15.58, = 0.01) were independently associated with ER.
CONCLUSION
An evidence-based cut-off value for ER after surgery for pNET was defined at 18 months. These data emphasized the importance of close follow-up in the first two years after surgery.
背景
识别胰腺神经内分泌肿瘤（pNETs）切除术后有早期复发（ER）风险的患者，可能有助于在术后制定辅助治疗方案并调整监测强度。
方法
利用多机构数据库识别1998年至2018年间接受pNETs手术切除的患者。采用最小值法，根据复发后生存期（PRS）的差异确定无复发生存期（RFS）的最佳截断值。确定早期复发的危险因素。
结果
在807例接受pNETs根治性切除的患者中，定义ER的最佳RFS时长为18个月（最小值为0.019）。ER患者（n = 49）的中位RFS为11.0个月（95%CI：8.5 - 12.60），而非ER患者（n = 77）为41.0个月（95%CI：35.0 - 45.9）。与非ER患者相比，ER患者的中位PRS更差（42.6个月对81.5个月，P = 0.04）。多变量分析显示，肿瘤大小（OR：1.20，95%CI：1.05 - 1.37，P = 0.007）和阳性淋巴结（OR：4.69，95%CI：1.41 - 15.58，P = 0.01）与ER独立相关。
结论
pNETs手术后ER的循证截断值定义为18个月。这些数据强调了术后头两年密切随访的重要性。
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