Amini Neda, Demyan Lyudmyla, Shah Manav, Standring Oliver, Gazzara Emma, Lad Neha, Deperalta Danielle K, Weiss Matthew, Deutsch Gary
Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA.
Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA.
Am J Surg. 2024 Jan;227:77-84. doi: 10.1016/j.amjsurg.2023.09.035. Epub 2023 Sep 27.
Since 2013, North American Neuroendocrine Tumor Society (NANETS) consensus-guidelines have endorsed consideration of surgical intervention for pancreatic- neuroendocrine tumors (PNET) with liver metastases.
Patients with non-functional PNET with liver only metastases from 2010 to 2019 were identified from the National Cancer Database.
34.7% underwent surgical intervention (13% PNET resection, 2.1% surgical management of liver metastases (SMLM), 19.5% PNET resection + SMLM). In multivariable analysis, government insurance, year of diagnosis>2013, increasing primary tumor size were associated with lower rate of surgical intervention. Receiving treatment at an academic center (OR 3.59, 95%CI 1.81-7.11; P < 0.001) or integrated cancer network (OR 3.21, 95%CI 1.57-6.54; P = 0.001) was associated with a higher rate of surgical intervention. The overall rate of surgical intervention decreased from 45.7% in 2010 to 23.0% in 2019.
Despite guideline recommendations and the suggested survival benefits, only one-third of patients underwent surgical intervention, potentially influenced by the rising utilization of systemic therapy in the past decade.
自2013年以来，北美神经内分泌肿瘤协会（NANETS）的共识指南已认可考虑对有肝转移的胰腺神经内分泌肿瘤（PNET）进行手术干预。
从国家癌症数据库中识别出2010年至2019年仅有肝转移的无功能性PNET患者。
34.7%的患者接受了手术干预（13%为PNET切除术，2.1%为肝转移瘤手术治疗（SMLM），19.5%为PNET切除术 + SMLM）。在多变量分析中，政府保险、诊断年份>2013年、原发肿瘤大小增加与手术干预率较低相关。在学术中心接受治疗（OR 3.59，95%CI 1.81 - 7.11；P < 0.001）或综合癌症网络（OR 3.21，95%CI 1.57 - 6.54；P = 0.001）与较高的手术干预率相关。手术干预的总体率从2010年的45.7%降至2019年的23.0%。
尽管有指南建议以及提示的生存获益，但只有三分之一的患者接受了手术干预，这可能受到过去十年中全身治疗使用增加的影响。
