浸润性生长可预测高分化无功能性胰腺神经内分泌肿瘤术后复发风险。
Infiltrative Growth Predicts the Risk of Recurrence After Surgery in Well-Differentiated Non-Functioning Pancreatic Neuroendocrine Tumors.
作者信息
Schiavo Lena Marco, Partelli Stefano, Andreasi Valentina, Muffatti Francesca, Redegalli Miriam, Brunetto Emanuela, Maghini Beatrice, Falke Monika, Cangi Maria Giulia, Perren Aurel, Falconi Massimo, Doglioni Claudio
机构信息
Pathology Unit, Pancreas Translational and Clinical Research Center, IRCCS Ospedale San Raffaele, ENETS Center of Excellence, Via Olgettina 60, 20132, Milan, Italy.
Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS Ospedale San Raffaele, ENETS Center of Excellence, Via Olgettina 60, 20132, Milan, Italy.
出版信息
Endocr Pathol. 2023 Mar;34(1):142-155. doi: 10.1007/s12022-022-09745-x. Epub 2022 Dec 24.
The incidence of well-differentiated non-functioning pancreatic neuroendocrine tumors (NF-PanNET) increased during the last decades. The risk of relapse after curative surgery, albeit low, is not negligible; moreover, adjuvant treatment is currently not an option and a reliable predictive model based on prognostic characteristics is urgently needed for tailoring a follow-up strategy. The histological classification of PanNET now relies only on the proliferative activity (mitosis and Ki67) and staging. In contrast to other endocrine neoplasms, the role of infiltrative growth pattern in NF-PanNET is not taken into consideration at present. In the current study, 247 consecutive patients who underwent surgical resection for a NF-PanNET were examined for the histological growth pattern of the tumor. Two distinct patterns (non-infiltrative vs. infiltrative) were described with the latter being further subclassified according to the type of structures invaded by the tumor (non-infiltrative: pattern 1; infiltration of adjacent pancreatic parenchyma and/or peripancreatic soft tissue: pattern 2; invasion of nearby organs and/or major vessels: pattern 3). The infiltrative growth resulted to be strongly associated with a poorer survival compared to a non-infiltrative growth (p < 0.001). In particular, the distinction between pancreatic parenchyma and/or peripancreatic soft tissue invasion versus adjacent organs and/or major vessels invasion was the most powerful predictor of recurrence after surgery at multivariate analysis (pattern 2 vs. pattern 1: HR 10.136, p = 0.028; pattern 3 vs. pattern 1: HR 15.775, p = 0.015). The infiltrative growth pattern could therefore provide additional prognostic information implementing the current grading and staging system.
在过去几十年里,高分化无功能性胰腺神经内分泌肿瘤(NF-PanNET)的发病率有所上升。尽管根治性手术后复发风险较低,但并非可以忽略不计;此外,目前辅助治疗并非一种选择,因此迫切需要一种基于预后特征的可靠预测模型来制定后续随访策略。目前,PanNET的组织学分类仅依赖于增殖活性(有丝分裂和Ki67)和分期。与其他内分泌肿瘤不同,目前尚未考虑浸润性生长模式在NF-PanNET中的作用。在本研究中,对247例接受手术切除的NF-PanNET患者的肿瘤组织学生长模式进行了检查。描述了两种不同的模式(非浸润性与浸润性),后者根据肿瘤侵犯的结构类型进一步细分(非浸润性:模式1;浸润相邻胰腺实质和/或胰腺周围软组织:模式2;侵犯附近器官和/或主要血管:模式3)。与非浸润性生长相比,浸润性生长与较差的生存率密切相关(p < 0.001)。特别是,在多变量分析中,胰腺实质和/或胰腺周围软组织浸润与相邻器官和/或主要血管浸润之间的区别是术后复发的最强预测因素(模式2与模式1:HR 10.136,p = 0.028;模式3与模式1:HR 15.775,p = 0.015)。因此,浸润性生长模式可以为当前的分级和分期系统提供额外的预后信息。