Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Pancreatology. 2022 Dec;22(8):1141-1147. doi: 10.1016/j.pan.2022.11.004. Epub 2022 Nov 13.
Progress of non-surgical treatments in the last decade has improved the prognosis of pancreatic neuroendocrine neoplasms (PanNEN). However, the improvement of surgery for advanced PanNEN remains unknown. This study aimed to investigate the chronological changes of the clinical impact of pancreatectomy for PanNEN.
Patients undergoing curative-intent pancreatectomy for PanNEN between 1991 and 2010 were categorized into the earlier period group, and those between 2011 and 2021 were into the later period group. Advanced PanNEN was defined as showing resectable synchronous liver metastases or invasion to portal venous systems or adjacent organs. The recurrence-free survival (RFS) and overall survival (OS) were analyzed among patients with non-advanced and advanced PanNENs. The independent prognostic risk factors were identified using a Cox proportional hazard model.
A total of 189 patients (n = 54 in the earlier period and n = 135 in the later period) were included. The proportion of advanced PanNEN increased from 15% to 30% (P = 0.027). The RFS and OS of non-advanced PanNEN were similar between the periods. Whereas, among patients with advanced PanNEN, the later period group showed improved prognosis; The 5-year RFS of the earlier period vs. the later period was 0% vs. 27%, and the 5-year OS was 38% vs. 82% (p = 0.013).
A radical surgical treatment for advanced PanNEN has shown prognostic improvement in this decade. However, more careful perioperative examinations and possibly, additional treatments are required for PanNEN with portal vein invasion.
过去十年中，非手术治疗的进展改善了胰腺神经内分泌肿瘤（PanNEN）的预后。然而，晚期 PanNEN 手术的改善情况尚不清楚。本研究旨在探讨胰腺切除术对 PanNEN 的临床影响的时间变化。
将 1991 年至 2010 年间接受根治性胰腺切除术治疗 PanNEN 的患者分为早期组，将 2011 年至 2021 年间接受治疗的患者分为晚期组。晚期 PanNEN 定义为可切除的同步肝转移或侵犯门静脉系统或邻近器官。分析非晚期和晚期 PanNEN 患者的无复发生存率（RFS）和总生存率（OS）。使用 Cox 比例风险模型确定独立的预后危险因素。
共纳入 189 例患者（早期组 n=54，晚期组 n=135）。晚期 PanNEN 的比例从 15%增加到 30%（P=0.027）。非晚期 PanNEN 两个时期的 RFS 和 OS 相似。然而，在晚期 PanNEN 患者中，晚期组的预后有所改善；早期组与晚期组的 5 年 RFS 分别为 0%和 27%，5 年 OS 分别为 38%和 82%（p=0.013）。
在过去十年中，对晚期 PanNEN 的激进手术治疗显示出了预后的改善。然而，对于门静脉侵犯的 PanNEN，需要更仔细的围手术期检查，可能还需要额外的治疗。
