Ye Jingyuan, Wu Hongyu, Li Jinzheng, Liu Changan
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Surg. 2022 Jul 8;9:890564. doi: 10.3389/fsurg.2022.890564. eCollection 2022.
The impact of surgery on non-functional pancreatic neuroendocrine tumors (NF-PNETs) ≤2 cm is controversial. This study sought to demonstrate the impact of surgery on the prognosis of NF-PNETs ≤2 cm with different biological behaviors.
Patients with NF-PNETs ≤2 cm from 2004 to 2015 in the Surveillance, Epidemiology, and End Results database were included in this study. An inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to evaluate the effect of surgery on the prognosis.
In the IPTW-adjusted Cox proportional hazards regression analysis, surgery improved the cancer-specific survival (CSS) in the overall cohort (hazard ratio [HR], 0.187; 95% confidence interval [CI], 0.102-0.343; < 0.001), patients with poorly differentiated or undifferentiated tumor grades (HR, 0.238; 95% CI, 0.105-0.64; < 0.001), patients with distant metastasis (HR, 0.102; 95% CI, 0.021-0.496; = 0.005), and patients with local invasion (HR, 0.059; 95% CI, 0.005-0.683; = 0.002). Surgery did not improve the CSS in patients with lymph node metastasis only (HR, 0.26; 95% CI, 0.0462-1.461; = 0.126) or patients with well or moderate differentiation while without distant and lymph node metastasis (HR, 0.387; 95% CI, 0.146-1.028; = 0.057).
Among patients with NF-PNETs ≤2 cm, different biological behaviors correlate with different prognostic impacts of surgery. As long as distant metastasis does not occur and the grade is well-moderately differentiated, these patients will not benefit from surgery no matter whether lymph node metastasis occurs or not. However, when local invasion appears in this group of patients, surgery should be performed. Moreover, patients with a tumor grade of poorly differentiated or undifferentiated or those with distant metastases may benefit from surgery.
手术对直径≤2 cm的无功能性胰腺神经内分泌肿瘤（NF-PNETs）的影响存在争议。本研究旨在证明手术对具有不同生物学行为的直径≤2 cm的NF-PNETs预后的影响。
本研究纳入了2004年至2015年监测、流行病学和最终结果数据库中直径≤2 cm的NF-PNETs患者。采用逆概率处理加权（IPTW）方法以减少选择偏倚。使用Kaplan-Meier生存分析和Cox比例风险回归来评估手术对预后的影响。
在IPTW调整的Cox比例风险回归分析中，手术改善了整个队列的癌症特异性生存（CSS）（风险比[HR]，0.187；95%置信区间[CI]，0.102 - 0.343；P < 0.001），肿瘤分级为低分化或未分化的患者（HR，0.238；95% CI，0.105 - 0.64；P < 0.001），有远处转移的患者（HR，0.102；95% CI，0.021 - 0.496；P = 0.005），以及有局部侵犯的患者（HR，0.059；95% CI，0.005 - 0.683；P = 0.002）。手术对仅发生淋巴结转移的患者（HR，0.26；95% CI，0.0462 - 1.461；P = 0.126）或肿瘤分级为高分化或中分化且无远处和淋巴结转移的患者的CSS没有改善（HR，0.387；95% CI，0.146 - 1.028；P = 0.057）。
在直径≤2 cm的NF-PNETs患者中，不同的生物学行为与手术的不同预后影响相关。只要不发生远处转移且分级为高分化至中分化，无论是否发生淋巴结转移，这些患者都不会从手术中获益。然而，当这组患者出现局部侵犯时，应进行手术。此外，肿瘤分级为低分化或未分化的患者或有远处转移的患者可能从手术中获益。
