Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Internal Medicine and Surgery (DIMEC); Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Br J Surg. 2022 Jul 15;109(8):733-738. doi: 10.1093/bjs/znac106.
The safety of observing small non-functioning pancreatic neuroendocrine tumours (NF-Pan-NETs) remains under debate.
This was a multicentre retrospective study of patients with small incidental NF-Pan-NETs. Survival of patients who underwent upfront surgery versus active surveillance was compared. The risk of death was matched with that in the healthy population. The excess hazard rate and probability of a normal lifespan (NLP) were calculated. Propensity score matching (PSM) with a 1 : 1 ratio was used to minimize the risk of selection bias.
Some 222 patients (43.7 per cent) underwent upfront surgery and 285 (56.3 per cent) were observed. The excess hazard rate for the entire cohort was quantifiable as 0.04 (95 per cent c.i. 0 to 0.08) deaths per 1000 persons per year, and the NLP was 99.7 per cent. Patients in the active surveillance group were older (median age 65 versus 58 years; P < 0.001), and more often had co-morbidity (45.3 versus 24.8 per cent; P = 0.001), and smaller tumours (median 12 versus 13 mm; P < 0.001), less frequently located in the pancreatic body-tail (59.5 versus 69.6 per cent; P = 0.008, 59.3 versus 73.9 per cent; P = 0.001). Median follow-up was longer for patients who underwent upfront surgery (5.6 versus 2.7 years; P < 0.001). After PSM, 118 patients per group were included. The excess hazard rates were 0.2 and 0.9 deaths per 1000 persons per year (P = 0.020) for patients in the active surveillance and upfront surgery groups respectively. Corresponding NLPs were 99.9 and 99.5 per cent respectively (P = 0.011).
Active surveillance of small incidental NF-Pan-NETs is a reasonable alternative to resection.
观察小的无功能性胰腺神经内分泌肿瘤（NF-Pan-NETs）的安全性仍存在争议。
这是一项多中心回顾性研究，纳入了偶然发现的小 NF-Pan-NETs 患者。比较了直接手术与主动监测的患者的生存情况。将死亡风险与健康人群进行匹配。计算超额危险率和正常寿命概率（NLP）。采用 1：1 比例的倾向评分匹配（PSM）以最小化选择偏倚的风险。
共有 222 例（43.7%）患者接受了直接手术，285 例（56.3%）患者接受了主动监测。整个队列的超额危险率可量化为每年每 1000 人 0.04（95%置信区间 0 至 0.08）例死亡，NLP 为 99.7%。主动监测组的患者年龄较大（中位数年龄 65 岁 vs 58 岁；P<0.001），合并症更多（45.3% vs 24.8%；P=0.001），肿瘤更小（中位数 12 毫米 vs 13 毫米；P<0.001），位于胰体尾的比例更小（59.5% vs 69.6%；P=0.008，59.3% vs 73.9%；P=0.001）。直接手术患者的中位随访时间较长（5.6 年 vs 2.7 年；P<0.001）。PSM 后，每组纳入 118 例患者。主动监测组和直接手术组的超额危险率分别为每年每 1000 人 0.2 和 0.9 例死亡（P=0.020）。相应的 NLP 分别为 99.9%和 99.5%（P=0.011）。
对小的偶然发现的 NF-Pan-NETs 进行主动监测是切除的合理替代方案。
