胰腺神经内分泌肿瘤患者的无复发生存率和疾病特异性生存率：一项针对413例患者的单中心回顾性研究
Recurrence-Free Survival and Disease-Specific Survival in Patients with Pancreatic Neuroendocrine Neoplasms: A Single-Center Retrospective Study of 413 Patients.
作者信息
Møller Stine, Langer Seppo W, Slott Cecilie, Krogh Jesper, Hansen Carsten Palnæs, Kjaer Andreas, Holmager Pernille, Klose Marianne, Garbyal Rajendra Singh, Knigge Ulrich, Andreassen Mikkel
机构信息
ENETS Center of Excellence, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.
Department of Endocrinology and Metabolism 7562, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.
出版信息
Cancers (Basel). 2023 Dec 24;16(1):100. doi: 10.3390/cancers16010100.
INTRODUCTION
The prognosis and impact of different prognostic factors in pancreatic neuroendocrine neoplasms (pNEN) remain controversial.
AIM
To investigate prognostic factors for recurrence-free survival and disease-specific survival in patients with pNEN, divided into three groups: patients undergoing surveillance (tumor size < 2 cm, group 1), patients followed after curative-intended surgery (group 2), and patients with unresectable disease or residual tumors after resection (group 3).
METHOD
A single-center retrospective study including consecutive patients over a 20-year period. Multivariate Cox regression analyses were performed to identify risk factors.
RESULTS
413 patients were included, with a mean (SD) age of 62 ± 14 years. In group 1 (n = 51), median (IQR) follow-up was 29 (21-34) months, and tumor size was 1.0 (0.8-1.4) cm. One progressed and had a tumor resection. In group 2 (n = 165), follow-up 59 (31-102) months, median tumor size 2 (1.2-3.4) cm, median Ki-67 index 5 (3-10)%, the 5-year recurrence rate was 21%. Tumor size ( < 0.001), Ki-67 index ( = 0.02), and location in the pancreatic head ( < 0.001) were independent risk factors. In group 3 (n = 197), follow-up 19 (6-46) months, median tumor size 4.2 (2.6-7.0) cm, Ki-67 index 17 (9-64)%, the median disease-specific survival was 22 (6-75) months-99 in NET G1; 54 in NET G2; 14 in NET G3; and 6 months in neuroendocrine carcinomas (NEC). Age ( = 0.029), plasma chromogranin A ( = 0.014), and proliferation, expressed by grade ( = 0.001) and Ki-67 index ( < 0.001), were risk factors.
CONCLUSION
Growth in pNET < 2 cm requiring surgery was observed in 1/51. Tumor size, Ki-67 index, and location in the head were prognostic factors for disease recurrence, while age, plasma chromogranin A, and proliferation predicted mortality in patients with unresectable disease or residual tumors after resection.
引言
胰腺神经内分泌肿瘤（pNEN）中不同预后因素的预后情况及影响仍存在争议。
目的
探讨pNEN患者无复发生存期和疾病特异性生存期的预后因素，将患者分为三组：接受监测的患者（肿瘤大小<2 cm，第1组）、接受根治性手术后随访的患者（第2组）以及不可切除疾病或切除后残留肿瘤的患者（第3组）。
方法
一项单中心回顾性研究，纳入20年间的连续患者。进行多变量Cox回归分析以确定危险因素。
结果
共纳入413例患者，平均（标准差）年龄为62±14岁。在第1组（n = 51）中，中位（四分位间距）随访时间为29（21 - 34）个月，肿瘤大小为1.0（0.8 - 1.4）cm。1例病情进展并接受了肿瘤切除。在第2组（n = 165）中，随访时间为59（31 - 102）个月，中位肿瘤大小为2（1.2 - 3.4）cm，中位Ki-67指数为5（3 - 10）%，5年复发率为21%。肿瘤大小（<0.001）、Ki-67指数（=0.02）以及位于胰头（<0.001）是独立危险因素。在第3组（n = 197）中，随访时间为19（6 - 46）个月，中位肿瘤大小为4.2（2.6 - 7.0）cm，Ki-67指数为17（9 - 64）%，疾病特异性生存期的中位数为22（6 - 75）个月——神经内分泌瘤G1为99个月；神经内分泌瘤G2为54个月；神经内分泌瘤G3为14个月；神经内分泌癌（NEC）为6个月。年龄（=0.029）、血浆嗜铬粒蛋白A（=0.014）以及由分级（=0.001）和Ki-67指数（<0.001）表示的增殖是危险因素。
结论
在51例患者中有1例观察到<2 cm的pNET生长需要手术。肿瘤大小、Ki-67指数以及位于胰头是疾病复发的预后因素，而年龄、血浆嗜铬粒蛋白A以及增殖可预测不可切除疾病或切除后残留肿瘤患者的死亡率。
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