小（≤20mm）无功能性胰腺神经内分泌肿瘤恶性风险评估的再评估。
Reappraisal of Malignant Risk Assessment for Small (≤20 mm) Non-functioning Pancreatic Neuroendocrine Tumors.
机构信息
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan.
出版信息
Ann Surg Oncol. 2023 Jun;30(6):3493-3500. doi: 10.1245/s10434-023-13193-0. Epub 2023 Feb 16.
BACKGROUND
Optimal management of non-functioning pancreatic neuroendocrine tumors (PanNETs) ≤20 mm is controversial. The biological heterogeneity of these tumors poses challenges when deciding between resection and observation.
METHODS
In this multicenter, retrospective cohort study, we analyzed all patients (n = 78) who underwent resection of non-functioning PanNETs ≤20 mm at three tertiary medical centers from 2004 to 2020 to assess the utility of preoperatively available radiological features and serological biomarkers of non-functioning PanNETs in choosing an optimal surgical indication. The radiological features included non-hyper-attenuation pattern on enhancement computed tomography (CT; hetero/hypo-attenuation) and main pancreatic duct (MPD) involvement, and serological biomarkers included elevation of serum elastase 1 and plasma chromogranin A (CgA) levels.
RESULTS
Of all small non-functioning PanNETs, 5/78 (6%) had lymph node metastasis, 11/76 (14%) were WHO grade II, and 9/66 (14%) had microvascular invasion; 20/78 (26%) had at least one of these high-risk pathological factors. In the preoperative assessment, hetero/hypo-attenuation and MPD involvement were observed in 25/69 (36%) and 8/76 (11%), respectively. Elevated serum elastase 1 and plasma CgA levels were observed in 1/33 (3%) and 0/11 (0%) patients, respectively. On multivariate logistic regression analysis, hetero/hypo-attenuation (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.7-22.2) and MPD involvement (OR 16.8, 95% CI 1.6-174.3) were significantly associated with the high-risk pathological factors. The combination of the two radiological worrisome features correctly predicted non-functioning PanNETs with high-risk pathological factors, with about 75% sensitivity, 79% specificity, and 78% accuracy.
CONCLUSIONS
This combination of radiological worrisome features can accurately predict non-functioning PanNETs that may require resection.
背景
对于直径≤20mm 的无功能性胰腺神经内分泌肿瘤（PanNETs），其最佳治疗策略仍存在争议。这些肿瘤的生物学异质性为临床决策带来挑战，即选择手术切除还是观察。
方法
本多中心回顾性队列研究纳入了 2004 年至 2020 年期间在三个三级医疗中心接受手术切除的直径≤20mm 的无功能性 PanNETs 患者（n=78），旨在评估术前影像学特征和无功能性 PanNETs 的血清学生物标志物在选择最佳手术适应证方面的作用。影像学特征包括增强 CT 上的非高强化模式（异质/低强化）和主胰管（MPD）受累，血清学标志物包括血清弹性蛋白酶 1 和血浆嗜铬粒蛋白 A（CgA）水平升高。
结果
所有直径较小的无功能性 PanNETs 中，5/78（6%）发生淋巴结转移，11/76（14%）为组织学分级Ⅱ级，9/66（14%）存在微血管侵犯；20/78（26%）存在至少一个高危病理因素。术前评估中，69 例患者中有 25 例（36%）存在异质/低强化，76 例中有 8 例（11%）存在 MPD 受累。33 例患者中有 1 例（3%）血清弹性蛋白酶 1 水平升高，11 例患者中无 1 例（0%）血浆 CgA 水平升高。多变量逻辑回归分析显示，异质/低强化（比值比[OR] 6.1，95%置信区间[CI] 1.7-22.2）和 MPD 受累（OR 16.8，95%CI 1.6-174.3）与高危病理因素显著相关。这两种影像学可疑特征的联合可准确预测具有高危病理因素的无功能性 PanNETs，其灵敏度约为 75%，特异度为 79%，准确率为 78%。
结论
这种联合的影像学可疑特征可准确预测可能需要手术切除的无功能性 PanNETs。
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