Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann Surg Oncol. 2024 Aug;31(8):4976-4985. doi: 10.1245/s10434-024-15249-1. Epub 2024 Apr 23.
Controversy exists regarding the benefit of lymphadenectomy for nonfunctional pancreatic neuroendocrine tumors (NF-PNET).
MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched for studies of pancreatic neuroendocrine tumors (PNET) published between 1990 and 2021. Studies of functional PNET were excluded. Reported incidence of lymph node metastasis (LNM) and survival analysis of either disease-free survival (DFS) or overall survival (OS) were required for inclusion.
Overall, 52 studies analyzing 24,608 PNET met the inclusion criteria. The reported LNM rate for NF-PNET ranged from 7 to 64 % (median 24.5%). Reported LNM rates ranged from 7 to 51% (median 11%) for NF-PNET< 2 cm in 14 studies and 29-47% (median 38%) in NF-PNET > 2 cm. In total, 19 studies (66%) reported LNM to have a negative impact on DFS. Additionally, 21 studies (60%) reported LNM to have a negative impact on OS. Two studies investigating the impact of lymphadenectomy (LND) found LND had the greatest impact for large, high-grade tumors. The overall quality of available evidence was low as assessed by the Grading of Recommendations, Assessment, Development, and Evaluation System.
Published literature evaluating the impact of regional LNM and LND in PNET is confounded by heterogeneity in practice patterns and the retrospective nature of these cohort studies. Most studies suggest high rates of LNM in NF-PNET that negatively impact DFS and OS. Given the high rate of LNM in NF-PNET and its potential detrimental effect on DFS and OS, we recommend lymphadenectomy be completed for NF-PNET > 2 cm and strongly considered for NF-PNET < 2 cm.
对于无功能性胰腺神经内分泌肿瘤（NF-PNET），淋巴结切除术的益处存在争议。
检索了 1990 年至 2021 年间发表的胰腺神经内分泌肿瘤（PNET）的 MEDLINE/PubMed、EMBASE 和 Cochrane 图书馆研究。排除了功能性 PNET 的研究。需要报告淋巴结转移（LNM）的发生率和无病生存率（DFS）或总生存率（OS）的生存分析，才能纳入研究。
共有 52 项分析了 24608 例 PNET 的研究符合纳入标准。NF-PNET 的报告 LNM 率为 7%至 64%（中位数 24.5%）。在 14 项研究中，NF-PNET<2cm 的报告 LNM 率为 7%至 51%（中位数 11%），NF-PNET>2cm 的报告 LNM 率为 29%至 47%（中位数 38%）。共有 19 项研究（66%）报告 LNM 对 DFS 有负面影响。此外，21 项研究（60%）报告 LNM 对 OS 有负面影响。两项研究调查了淋巴结清扫术（LND）的影响，发现 LND 对大、高级别肿瘤的影响最大。根据推荐分级、评估、发展和评估系统评估，可用证据的总体质量较低。
评估 PNET 中局部 LNM 和 LND 影响的已发表文献受到实践模式异质性和这些队列研究回顾性的影响。大多数研究表明 NF-PNET 的 LNM 率较高，对 DFS 和 OS 有负面影响。鉴于 NF-PNET 中 LNM 的高发生率及其对 DFS 和 OS 的潜在不利影响，我们建议对 NF-PNET>2cm 进行淋巴结清扫术，并强烈考虑对 NF-PNET<2cm 进行淋巴结清扫术。
