Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
Front Endocrinol (Lausanne). 2022 Jul 18;13:928341. doi: 10.3389/fendo.2022.928341. eCollection 2022.
Expectant observation and aggressive surgery are both recommended for small nonfunctional pancreatic neuroendocrine tumors (NF-PanNETs). However, the optimal management of small NF-PanNETs remains disputable due to the heterogeneous clinical behavior.
Patients who were diagnosed with pancreatic neuroendocrine neoplasms (PanNENs) between 2000 and 2018 were identified from the surveillance, epidemiology, and end results (SEER) database and reviewed retrospectively. Tumor aggressiveness was defined as poor differentiation, lymph node involvement, liver involvement, and advanced stage. The best cutoff of tumor size associated with tumor aggressiveness was determined through the receiver operating characteristic (ROC) curve analysis. Univariate and multivariate analyses were used to identify prognostic factors in patients with tumors of ≤2 cm.
A total of 5,172 patients with PanNENs were enrolled, including 1,760 (34.0%) tumors ≤2 cm and 3,412 (66.0%) tumors >2 cm. A 2.5-cm cutoff size was found to be associated with a satisfactory ability in predicting tumor aggressiveness. On multivariate analysis, age, gender, ethnicity, tumor grade, tumor number, and stage were independent prognostic factors for overall survival (OS) in patients with tumors less than or equal to 2 cm in size. A total of 1,621 patients were diagnosed with NF-PanNETs according to the WHO classification, of whom 1,350 underwent surgery, 271 performed active observation. The OS was significantly better in the surgery group compared to the observation group regardless of propensity score analysis. Additionally, a total of 407 patients were selected based on the multivariate Cox regression analysis, of whom 46 underwent observation, 361 underwent surgery, and the OS was comparable.
Expectant observation may be a reasonable alternative to aggressive surgical resection in highly selected small NF-PanNET patients. Also, the decision to observe versus surgery should not only be based on tumor size alone but also take into account other important clinicopathological factors.
对于小的无功能性胰腺神经内分泌肿瘤（NF-PanNETs），建议进行期待观察和积极手术。然而，由于临床行为的异质性，小的 NF-PanNETs 的最佳治疗方法仍存在争议。
从监测、流行病学和最终结果（SEER）数据库中确定了 2000 年至 2018 年间诊断为胰腺神经内分泌肿瘤（PanNENs）的患者，并进行回顾性复习。肿瘤侵袭性定义为分化差、淋巴结受累、肝转移和晚期。通过接受者操作特征（ROC）曲线分析确定与肿瘤侵袭性相关的最佳肿瘤大小截断值。使用单变量和多变量分析确定肿瘤大小≤2cm 的患者的预后因素。
共纳入 5172 例 PanNENs 患者，其中 1760 例（34.0%）肿瘤≤2cm，3412 例（66.0%）肿瘤>2cm。发现 2.5cm 截断值与预测肿瘤侵袭性的能力相当。多变量分析显示，年龄、性别、种族、肿瘤分级、肿瘤数量和分期是肿瘤大小≤2cm 的患者总生存（OS）的独立预后因素。根据世界卫生组织（WHO）分类，共有 1621 例患者被诊断为 NF-PanNETs，其中 1350 例行手术，271 例行积极观察。与倾向评分分析无关，手术组的 OS 明显优于观察组。此外，根据多变量 Cox 回归分析，共选择了 407 例患者，其中 46 例观察，361 例手术，OS 相当。
在高度选择的小 NF-PanNET 患者中，期待观察可能是积极手术切除的合理替代方案。此外，观察与手术的决定不应仅基于肿瘤大小，还应考虑其他重要的临床病理因素。
