小肠神经内分泌肿瘤患者分级和转移淋巴结模式的预后差异。
Prognostic differences in grading and metastatic lymph node pattern in patients with small bowel neuroendocrine tumors.
机构信息
Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Department of Hepatology and Gastroenterology, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
出版信息
Langenbecks Arch Surg. 2023 Jun 19;408(1):237. doi: 10.1007/s00423-023-02956-8.
PURPOSE
Neuroendocrine tumors of the small intestine (si-NET) describe a heterogenous group of neoplasms. Based on the Ki67 proliferation index si-NET are divided into G1 (Ki67 < 2%), G2 (Ki67 3-20%) and rarely G3 (Ki67 > 20%) tumors. However, few studies evaluate the impact of tumor grading on prognosis in si-NET. Moreover, si-NET can form distinct lymphatic spread patterns to the mesenteric root, aortocaval lymph nodes, and distant organs. This study aims to identify prognostic factors within the lymphatic spread patterns and grading.
METHODS
Demographic, pathological, and surgical data of 208 (90 male, 118 female) individuals with si-NETs treated at Charité University Medicine Berlin between 2010 and 2020 were analyzed retrospectively.
RESULTS
A total of 113 (54.5%) specimens were defined as G1 and 93 (44.7%) as G2 tumors. Interestingly, splitting the G2 group in two subgroups: G2 low (Ki67 3-9%) and G2 high (Ki67 10-20%), displayed significant differences in overall survival (OS) (p = 0.008) and progression free survival (PFS) (p = 0.004) between these subgroups. Remission after surgery was less often achieved in patients with higher Ki67 index (> 10%). Lymph node metastases (N +) were present in 174 (83.6%) patients. Patients with isolated locoregional disease showed better PFS and OS in comparison to patients with additional aortocaval and distant lymph node metastases.
CONCLUSION
Lymphatic spread pattern influences patient outcome. In G2 tumors, low and high grading shows heterogenous outcome in OS and PFS. Differentiation within this group might impact follow-up, adjuvant treatment, and surgical strategy.
目的
小肠神经内分泌肿瘤（si-NET）描述了一组异质性的肿瘤。根据 Ki67 增殖指数，si-NET 分为 G1（Ki67<2%）、G2（Ki67 为 3-20%）和罕见的 G3（Ki67>20%）肿瘤。然而，很少有研究评估肿瘤分级对 si-NET 预后的影响。此外，si-NET 可以形成向肠系膜根部、腹主动脉旁淋巴结和远处器官的不同淋巴扩散模式。本研究旨在确定淋巴扩散模式和分级中的预后因素。
方法
回顾性分析了 2010 年至 2020 年期间在柏林 Charité 大学医学中心接受治疗的 208 名（90 名男性，118 名女性）si-NET 患者的人口统计学、病理和手术数据。
结果
共有 113 例（54.5%）标本定义为 G1，93 例（44.7%）为 G2 肿瘤。有趣的是，将 G2 组分为两个亚组：G2 低（Ki67 为 3-9%）和 G2 高（Ki67 为 10-20%），这两个亚组在总生存（OS）（p=0.008）和无进展生存（PFS）（p=0.004）方面存在显著差异。Ki67 指数较高（>10%）的患者术后缓解率较低。174 例（83.6%）患者存在淋巴结转移（N+）。与仅存在局部区域疾病的患者相比，存在腹主动脉旁和远处淋巴结转移的患者的 PFS 和 OS 较差。
结论
淋巴扩散模式影响患者预后。在 G2 肿瘤中，低分级和高分级在 OS 和 PFS 方面表现出不同的结果。在该组内进行分级可能会影响随访、辅助治疗和手术策略。
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