Marx Mariola, Caillol Fabrice, Godat Sébastien, Poizat Flora, Oumrani Sarra, Ratone Jean-Philippe, Hoibian Solène, Dahel Yanis, Oziel-Taieb Sandrine, Niccoli Patricia, Ewald Jacques, Mitry Emmanuel, Giovannini Marc
Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland (Mariola Marx, Sébastien Godat, Sarra Oumrani).
Department of Gastroenterology (Fabrice Caillol, Jean-Philippe Ratone, Solène Hoibian, Yanis Dahel, Marc Giovannini).
Ann Gastroenterol. 2023 Nov-Dec;36(6):686-693. doi: 10.20524/aog.2023.0833. Epub 2023 Oct 30.
Current guidelines consider observation a reasonable strategy for G1 or G2 nonfunctional pancreatic neuroendocrine tumors (nf pNETs) ≤2 cm. We aimed to characterize their natural behavior and confront the data with the outcomes of patients undergoing upfront surgery.
Data from patients with histologically confirmed nf pNETs ≤2 cm, managed at a single tertiary referral center between 2002 and 2020, were retrospectively reviewed.
Thirty-nine patients (mean age 62.1 years, 56% male) with 43 lesions (mean size 12.7±3.9 mm; 32 grade 1 [G1] and 7 grade 2 lesions [G2]) were managed by careful surveillance. Progression was observed in 15 lesions (35%; mean follow up 47 months). Six patients (18%) underwent secondary surgery because of an increase in tumor size or dilation of the main pancreatic duct; 3 of them had lymph node metastasis in the resected specimen. Surgery was followed by pancreatic fistula in 2/6 patients, 1 of whom died. Fourteen patients (mean age 59 years, 64.3% female, mean size of lesions 11.4±3.1 mm) underwent pancreatic surgery immediately after diagnosis. The surgery-associated complication rate was 57.1% (8/14). Of the 14 patients, 13 remained recurrence free (mean follow up 67 months). Recurrent metastatic disease was observed 3 years after pancreaticoduodenectomy (R0, 15 mm G2 lesion, 0 N+/8 N) in 1 patient.
The behavior of small nf pNETs is difficult to predict, as there is evidence for malignant behavior in a subgroup of patients, even after surgical treatment. Optimal management remains challenging, as pancreatic surgery is associated with significant morbidity.
当前指南认为，对于直径≤2cm的G1或G2级无功能胰腺神经内分泌肿瘤（nf pNETs），观察是一种合理的策略。我们旨在描述其自然行为，并将数据与接受 upfront手术的患者的结果进行对比。
回顾性分析了2002年至2020年间在单一三级转诊中心接受治疗的组织学确诊的直径≤2cm的nf pNETs患者的数据。
39例患者（平均年龄62.1岁，56%为男性）有43个病灶（平均大小12.7±3.9mm；32个为1级[G1]病灶，7个为2级[G2]病灶）接受了密切监测。15个病灶（35%）出现进展（平均随访47个月）。6例患者（18%）因肿瘤大小增加或主胰管扩张而接受了二次手术；其中3例在切除标本中有淋巴结转移。6例患者中有2例术后发生胰瘘，其中1例死亡。14例患者（平均年龄59岁，64.3%为女性，病灶平均大小11.4±3.1mm）在诊断后立即接受了胰腺手术。手术相关并发症发生率为57.1%（8/14）。14例患者中，13例无复发（平均随访67个月）。1例患者在胰十二指肠切除术后3年（R0，15mm G2病灶，0 N+/8 N）出现复发性转移性疾病。
小的nf pNETs的行为难以预测，因为有证据表明即使在手术治疗后，部分患者仍存在恶性行为。由于胰腺手术的发病率较高，最佳治疗方案仍然具有挑战性。
