Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Department of Oncology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Eur J Radiol. 2023 May;162:110772. doi: 10.1016/j.ejrad.2023.110772. Epub 2023 Mar 15.
To define the prognostic role of lymph node involvement (LNI) in patients with pancreatic neuroendocrine tumors (PNETs) and identify predictors of LNI using a comprehensive multifactor analysis focusing on preoperative radiological features.
This study included 236 patients with preoperative computed tomography who underwent radical surgical resection of PNETs at our hospital between 2009 and 2019. Univariate and multivariable logistic regression analyses were performed to investigate the risk factors associated with LNI and tumor recurrence. The disease-free survival (DFS) rates with and without LNI were compared.
Forty-four of the 236 patients (18.6%) had LNI. Biliopancreatic duct dilatation (odds ratio [OR], 2.295; 95% confidence interval [CI], 1.046-5.035; p = 0.038), tumor margin (OR, 2.189; 95% CI, 1.034-4.632; p = 0.041), and WHO grade (G2: OR, 2.923; 95% CI, 1.005-8.507; p = 0.049; G3: OR, 12.067; 95% CI, 3.057-47.629; p < 0.001) were independent risk factors of LNI in PNETs. Multivariable analysis showed that LNI (OR, 2.728; 95% CI, 1.070-6.954; p = 0.036), G3 (OR, 4.894; 95% CI, 1.047-22.866; p = 0.044), and biliopancreatic duct dilatation (OR, 2.895; 95% CI, 1.124-7.458; p = 0.028) were associated with PNET recurrence in patients after surgery. Patients with LNI had a significantly worse DFS than those without LNI (3-year DFS: 85.9 vs. 96.7%; p < 0.001; 5-year DFS: 65.1 vs. 93.9%; p < 0.001).
LNI was associated with decreased DFS. Biliopancreatic duct dilatation, irregular tumor margins, and grades G2 and G3 were independent risk factors for LNI.
通过综合多因素分析，确定术前影像学特征，明确淋巴结受累（LNI）在胰腺神经内分泌肿瘤（PNETs）患者中的预后作用，并确定 LNI 的预测因子。
本研究纳入了 2009 年至 2019 年期间在我院接受根治性手术切除的 236 例术前接受计算机断层扫描的 PNETs 患者。采用单因素和多因素逻辑回归分析探讨与 LNI 和肿瘤复发相关的危险因素。比较有无 LNI 的患者无病生存（DFS）率。
236 例患者中有 44 例（18.6%）存在 LNI。胰胆管扩张（比值比 [OR]，2.295；95%置信区间 [CI]，1.046-5.035；p=0.038）、肿瘤边界（OR，2.189；95%CI，1.034-4.632；p=0.041）和世界卫生组织（WHO）分级（G2：OR，2.923；95%CI，1.005-8.507；p=0.049；G3：OR，12.067；95%CI，3.057-47.629；p<0.001）是 PNETs 中 LNI 的独立危险因素。多因素分析显示，LNI（OR，2.728；95%CI，1.070-6.954；p=0.036）、G3（OR，4.894；95%CI，1.047-22.866；p=0.044）和胰胆管扩张（OR，2.895；95%CI，1.124-7.458；p=0.028）与术后 PNET 患者的肿瘤复发相关。存在 LNI 的患者 DFS 明显较差，无 LNI 患者的 DFS 较好（3 年 DFS：85.9% vs. 96.7%；p<0.001；5 年 DFS：65.1% vs. 93.9%；p<0.001）。
LNI 与 DFS 降低有关。胰胆管扩张、肿瘤边界不规则和 G2 和 G3 级是 LNI 的独立危险因素。
