A.C. Camargo Cancer Center, Sao Paulo, Brazil.
Department of Medicine/Epidemiology and Population Sciencies, Baylor College of Medicine, Houston, Texas, USA.
J Surg Oncol. 2022 Jul;126(1):168-174. doi: 10.1002/jso.26931.
Incidence of pancreatic neuroendocrine tumors (pNETS) seems to be rising over the years, with many cases incidentally diagnosed. Surgery and active surveillance are current treatment modalities for small pNETS. We review our institutional series and compare outcomes for small asymptomatic and nonfunctioning tumors.
This retrospective cohort study included patients with 2 cm or less and well differentiated pNETS at a single Brazilian Cancer Center. From 2002 to 2020, patients received active surveillance or surgery as a treatment strategy. Short and long-term results were compared.
Sixty-four patients were included, 41 in surgical strategy and 23 in the active surveillance approach. Baseline group characteristics were comparable. More patients on active surveillance underwent abdominal magnetic resonance imaging (MRI) and had tumors located in the pancreatic head (41% vs. 17%, p = 0.038). Minimally invasive procedure was chosen in 80.1% of the surgical patients. No patient died after surgery. Median follow-up period was 38.6 and 46.4 months for active surveillance and surgery cohorts, respectively. No difference in disease progression rate was observed.
Both approaches seem to be safe for small pNETs. Long-term outcome and quality of life should be considered when discussing such options with patients.
近年来，胰腺神经内分泌肿瘤（pNET）的发病率似乎呈上升趋势，许多病例为偶然诊断。手术和主动监测是治疗小 pNET 的当前方法。我们回顾了我们的机构系列，并比较了小无症状和无功能肿瘤的治疗结果。
这项回顾性队列研究纳入了在巴西一家癌症中心诊断为 2cm 或更小且分化良好的 pNET 的患者。从 2002 年到 2020 年，患者接受了主动监测或手术作为治疗策略。比较了短期和长期结果。
共纳入 64 例患者，其中 41 例接受手术策略，23 例接受主动监测。基线组特征具有可比性。更多接受主动监测的患者接受了腹部磁共振成像（MRI）检查，且肿瘤位于胰头部（41% vs. 17%，p=0.038）。80.1%的手术患者选择了微创手术。手术后无患者死亡。主动监测组和手术组的中位随访时间分别为 38.6 和 46.4 个月。未观察到疾病进展率的差异。
对于小 pNET，这两种方法似乎都是安全的。在与患者讨论这些选择时，应考虑长期结果和生活质量。
