Hoyos Sergio, Posada-Moreno Pablo, Guzman-Arango Natalia, Chanci-Drago Romario, Chavez Jaime, Andrés-Duarte Alvaro, Salazar-Ochoa Santiago
Hepatobilary and Liver Transplant Unit, Hospital Pablo Tobon Uribe and Gastrohepathology Group Universidad de Antioquia, Medellin 050034, Antioquia, Colombia.
Department of General Surgery, Universidad Pontificia Bolivariana, Medellín 050034, Antioquia, Colombia.
World J Gastrointest Oncol. 2024 May 15;16(5):1756-1762. doi: 10.4251/wjgo.v16.i5.1756.
Pancreatic neuroendocrine tumors (PNETs) are relatively rare but rank as the second most common pancreatic neoplasm. They can be functional, causing early metabolic disturbances due to hormone secretion, or non-functional and diagnosed later based on tumor size-related symptoms. Recent diagnoses of PNETs under 2 cm in size have sparked debates about their management; some practitioners advocate for surgical removal and others suggest observation due to the tumors' lower potential for malignancy. However, it is unclear whether managing these small tumors expectantly is truly safe.
To evaluate poor prognostic factors in PNETs based on tumor size (> 2 cm or < 2 cm) in surgically treated patients.
This cohort study included 64 patients with PNETs who underwent surgical resection between 2006 and 2019 at a high-complexity reference hospital in Medellín, Colombia. To assess patient survival, quarterly follow-ups were conducted during the first year after surgery, followed by semi-annual consultations at the hospital's hepatobiliary surgery department. Qualitative variables were described using absolute and relative frequencies, and quantitative variables were expressed using measures of central tendency and their corresponding measures of dispersion.
The presence of lymph node involvement, neural involvement, and lymphovascular invasion were all associated with an increased risk of mortality, with hazard ratios of 5.68 (95%CI: 1.26-25.61, = 0.024), 6.44 (95%CI: 1.43-28.93, = 0.015), and 24.87 (95%CI: 2.98-207.19, = 0.003), respectively. Neural involvement and lymphovascular invasion were present in tumors smaller than 2 cm in diameter and those larger than 2 cm in diameter. The recurrence rates between the two tumor groups were furthermore similar: 18.2% for tumors smaller than 2 cm and 21.4% for tumors larger than 2 cm. Patient survival was additionally comparable between the two tumor groups.
Tumor size does not dictate prognosis; lymph node and lymphovascular involvement affect mortality, which highlights that histopathological factors-rather than tumor size-may play a role in management.
胰腺神经内分泌肿瘤（PNETs）相对罕见，但却是第二常见的胰腺肿瘤。它们可能具有功能性，由于激素分泌导致早期代谢紊乱，也可能是非功能性的，根据与肿瘤大小相关的症状在后期被诊断出来。最近对直径小于2 cm的PNETs的诊断引发了关于其治疗的争论；一些从业者主张手术切除，而另一些人则建议观察，因为这些肿瘤的恶性潜能较低。然而，对于这些小肿瘤进行观察是否真的安全尚不清楚。
基于手术治疗患者的肿瘤大小（>2 cm或<2 cm）评估PNETs的不良预后因素。
这项队列研究纳入了2006年至2019年期间在哥伦比亚麦德林一家高复杂性参考医院接受手术切除的64例PNETs患者。为评估患者生存情况，术后第一年每季度进行随访，随后在医院肝胆外科进行半年一次的会诊。定性变量用绝对频率和相对频率描述，定量变量用集中趋势测量值及其相应的离散度测量值表示。
淋巴结受累、神经受累和淋巴管侵犯均与死亡风险增加相关，风险比分别为5.68（95%CI：1.26 - 25.61，P = 0.024）、6.44（95%CI：1.43 - 28.93，P = 0.015）和24.87（95%CI：2.98 - 207.19，P = 0.003）。神经受累和淋巴管侵犯在直径小于2 cm和大于2 cm的肿瘤中均有出现。此外，两组肿瘤的复发率相似：直径小于2 cm的肿瘤为18.2%，直径大于2 cm的肿瘤为21.4%。两组肿瘤患者的生存情况也相当。
肿瘤大小并不决定预后；淋巴结和淋巴管受累影响死亡率，这突出表明组织病理学因素而非肿瘤大小可能在治疗中起作用。
