小肠和胰腺神经内分泌肿瘤诊断检查的发病率、临床表现及指征趋势
Incidence, Clinical Presentation and Trends in Indication for Diagnostic Work-Up of Small Intestinal and Pancreatic Neuroendocrine Tumors.
作者信息
Stensbøl Anna Bryan, Krogh Jesper, Holmager Pernille, Klose Marianne, Oturai Peter, Kjaer Andreas, Hansen Carsten Palnæs, Federspiel Birgitte, Langer Seppo W, Knigge Ulrich, Andreassen Mikkel
机构信息
ENETS Center of Excellence, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.
Department of Endocrinology and Metabolism 7562, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.
出版信息
Diagnostics (Basel). 2021 Nov 3;11(11):2030. doi: 10.3390/diagnostics11112030.
BACKGROUND
The incidence of small intestinal (SI) and pancreatic neuroendocrine tumors (siNETs and pNETs) seems to have increased. The increased frequency of incidental findings might be a possible explanation. The study aimed to examine (1) changes in incidence and the stage at diagnosis (2010-2011 vs. 2019-2020), (2) changes in the initial indication for diagnostic workup and 3) the differences in stage between incidentally discovered vs. symptomatic disease during the entire study period.
METHODS
We performed a retrospective study, that includes consecutive siNET and pNET patients referred to the Copenhagen ENETS center of excellence in 2010-2011 and 2019-2020.
RESULTS
The annual incidence of siNET per 100,000 increased from 1.39 to 1.84, ( = 0.05). There was no change in the stage at diagnosis, and in both periods approximately 30% of patients were incidentally diagnosed ( = 0.62). Dissemination was found in 72/121 (60%) of symptomatic vs. 22/50 (44%) of incidentally discovered SI tumors in the entire cohort, ( = 0.06). The annual incidence of pNET increased from 0.42 to 1.39 per 100,000, ( < 0.001). The proportion of patients with disseminated disease decreased from 8/21 (38%) to 12/75 (16%), ( = 0.02) and the number of incidental findings increased from 4/21 (19%) to 43/75 (57%), ( = 0.002). More symptomatic patients had disseminated disease compared to patients with incidentally discovered tumors (15/49 (31%) vs. 5/47 (11%), ( = 0.01)).
CONCLUSION
The incidence of siNET and pNETs increased over the past decade. For siNETs, the stage of disease and the distribution of symptomatic vs. incidentally discovered tumors were unchanged between the two periods. Patients with pNETs presented with more local and incidentally discovered tumors in the latter period. Patients with incidentally discovered siNETs had disseminated disease in 44% of the overall cases. The vast majority of incidentally found pNETs were localized.
背景
小肠（SI）和胰腺神经内分泌肿瘤（siNETs和pNETs）的发病率似乎有所上升。偶然发现病例的频率增加可能是一个解释。本研究旨在探讨（1）发病率及诊断时分期的变化（2010 - 2011年与2019 - 2020年），（2）诊断性检查初始指征的变化，以及（3）在整个研究期间偶然发现的疾病与有症状疾病在分期上的差异。
方法
我们进行了一项回顾性研究，纳入了2010 - 2011年和2019 - 2020年转诊至哥本哈根ENETS卓越中心的连续的siNET和pNET患者。
结果
每10万人中siNET的年发病率从1.39升至1.84，（P = 0.05）。诊断时的分期没有变化，两个时期中约30%的患者是偶然诊断的（P = 0.62）。在整个队列中，有症状的SI肿瘤患者中72/121（60%）出现转移，而偶然发现的SI肿瘤患者中为22/50（44%），（P = 0.06）。每10万人中pNET的年发病率从0.42升至1.39，（P < 0.001）。发生转移的患者比例从8/21（38%）降至12/75（16%），（P = 0.02），偶然发现的病例数从4/21（19%）增至43/75（57%），（P = 0.002）。与偶然发现肿瘤的患者相比，有症状的患者发生转移的更多（15/49（31%）对5/47（11%），（P = 0.01））。
结论
在过去十年中，siNET和pNET的发病率有所上升。对于siNETs，两个时期疾病的分期以及有症状与偶然发现肿瘤的分布没有变化。在后一时期，pNET患者出现更多局部和偶然发现的肿瘤。偶然发现的siNET患者中44%的总体病例发生了转移。绝大多数偶然发现的pNET是局限性的。
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