HPB Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD.
Ann Surg. 2023 Nov 1;278(5):e1063-e1067. doi: 10.1097/SLA.0000000000005809. Epub 2023 Jan 24.
The objective of this study was to describe the pattern of recurrence, treatments received, as well the oncological outcomes, of pancreatic neuroendocrine tumors (PanNETs) following curative surgery.
PanNETs recur in 10% to 15% of cases following surgery. Information on the natural history and management of recurring disease is lacking.
Patients with PanNET that underwent curative surgery at 4 institutions between 2000 and 2019 were identified. Patients with poorly differentiated tumors, unknown tumor grade and differentiation, hereditary syndromes, unknown margin or R2 status, metastatic, and those that had neoadjuvant treatment or perioperative mortality were excluded. Clinical variables were assessed including first site of recurrence, treatment received, and survival outcomes.
A total of 1402 patients were included: 957 (74%) had grade 1, 322 (25%) had grade 2, and 13 (1%) had grade 3 tumors. Median follow-up was 4.8 years (interquartile range: 2-8.2 years). Cumulative incidence of recurrence at 5 years was 13% (95% CI: 11%-15.2%) for distant disease, 1.4% (95% CI: 0.8%-2.3%) for locoregional recurrence, and 0.8% (95% CI: 0.4%-1.5%) for abdominal nodal recurrence. Patients who recurred had 2.89 increased risk of death (95% CI: 2-4.1) as compared with patients who did not recur. Therapy postrecurrence included: somatostatin analogs in 111 (61.0%), targeted therapies in 48 (26.4%), liver-directed therapies in 61 (33.5%), peptide receptor radionuclide therapy in 30 (16.5%), and surgery in 46 (25.3%) patients. Multiple treatments were used in 103 (57%) cases. After the first recurrence, 5-year overall survival was 74.6% (95% CI: 67.4%-82.5%).
Recurrence following surgery is infrequent but reduces survival. Most recurrences are distant and managed with multiple therapies. Prospective studies are needed to establish strategies for surveillance and the sequence of treatment to control the disease and prolong survival.
本研究旨在描述胰腺神经内分泌肿瘤（PanNETs）根治性手术后的复发模式、治疗方法以及肿瘤学结局。
PanNETs 术后有 10%至 15%的病例会复发。目前缺乏关于复发疾病自然史和管理的信息。
在四家机构，回顾性分析了 2000 年至 2019 年间接受根治性手术的 PanNET 患者。排除了分化不良肿瘤、肿瘤分级和分化程度未知、遗传性综合征、切缘或 R2 状态未知、转移性肿瘤、接受新辅助治疗或围手术期死亡的患者。评估了临床变量，包括首次复发部位、接受的治疗以及生存结局。
共纳入 1402 例患者：957 例（74%）为 G1 级，322 例（25%）为 G2 级，13 例（1%）为 G3 级。中位随访时间为 4.8 年（四分位距：2-8.2 年）。5 年时远处疾病的累积复发率为 13%（95%CI：11%-15.2%），局部复发率为 1.4%（95%CI：0.8%-2.3%），腹部淋巴结复发率为 0.8%（95%CI：0.4%-1.5%）。与未复发的患者相比，复发患者的死亡风险增加 2.89 倍（95%CI：2-4.1）。复发后的治疗方法包括：111 例（61.0%）使用生长抑素类似物，48 例（26.4%）使用靶向治疗，61 例（33.5%）使用肝定向治疗，30 例（16.5%）使用肽受体放射性核素治疗，46 例（25.3%）使用手术治疗。103 例（57%）患者采用了多种治疗方法。首次复发后，5 年总生存率为 74.6%（95%CI：67.4%-82.5%）。
手术后复发并不常见，但会降低生存率。大多数复发为远处转移，采用多种治疗方法治疗。需要开展前瞻性研究，以确定监测策略和治疗顺序，从而控制疾病并延长患者生存时间。
