Pancreas Translational and Clinical Research Centre, Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
BJS Open. 2024 Jul 2;8(4). doi: 10.1093/bjsopen/zrae083.
The lack of preoperative prognostic factors to accurately predict tumour aggressiveness in non-functioning pancreatic neuroendocrine tumours may result in inappropriate management decisions. This study aimed to critically evaluate the adequacy of surgical treatment in patients with resectable non-functioning pancreatic neuroendocrine tumours and investigate preoperative features of surgical appropriateness.
A retrospective study was conducted on patients who underwent curative surgery for non-functioning pancreatic neuroendocrine tumours at San Raffaele Hospital (2002-2022). The appropriateness of surgical treatment was categorized as appropriate, potential overtreatment and potential undertreatment based on histologic features of aggressiveness and disease relapse within 1 year from surgery (early relapse).
A total of 384 patients were included. Among them, 230 (60%) received appropriate surgical treatment, whereas the remaining 154 (40%) underwent potentially inadequate treatment: 129 (34%) experienced potential overtreatment and 25 (6%) received potential undertreatment. The appropriateness of surgical treatment was significantly associated with radiological tumour size (P < 0.001), tumour site (P = 0.012), surgical technique (P < 0.001) and year of surgical resection (P < 0.001). Surgery performed before 2015 (OR 2.580, 95% c.i. 1.570 to 4.242; P < 0.001), radiological tumour diameter < 25.5 mm (OR 6.566, 95% c.i. 4.010 to 10.751; P < 0.001) and pancreatic body/tail localization (OR 1.908, 95% c.i. 1.119 to 3.253; P = 0.018) were identified as independent predictors of potential overtreatment. Radiological tumour size was the only independent determinant of potential undertreatment (OR 0.291, 95% c.i. 0.107 to 0.791; P = 0.016). Patients subjected to potential undertreatment exhibited significantly poorer disease-free survival (P < 0.001), overall survival (P < 0.001) and disease-specific survival (P < 0.001).
Potential overtreatment occurs in nearly one-third of patients undergoing surgery for non-functioning pancreatic neuroendocrine tumours. Tumour diameter emerges as the sole variable capable of predicting the risk of both potential surgical overtreatment and undertreatment.
由于缺乏术前预测肿瘤侵袭性的预后因素，可能导致功能性胰腺神经内分泌肿瘤的治疗决策不当。本研究旨在批判性评估可切除无功能性胰腺神经内分泌肿瘤患者的手术治疗是否充分，并探讨手术适当性的术前特征。
对 2002 年至 2022 年在圣拉斐尔医院接受无功能性胰腺神经内分泌肿瘤根治性手术的患者进行回顾性研究。根据组织学侵袭性特征和术后 1 年内疾病复发（早期复发），将手术治疗的适当性分为适当、潜在过度治疗和潜在治疗不足。
共纳入 384 例患者。其中，230 例（60%）接受了适当的手术治疗，而其余 154 例（40%）接受了潜在的不充分治疗：129 例（34%）为潜在过度治疗，25 例（6%）为潜在治疗不足。手术治疗的适当性与影像学肿瘤大小（P<0.001）、肿瘤部位（P=0.012）、手术技术（P<0.001）和手术切除年份（P<0.001）显著相关。2015 年前进行的手术（OR 2.580，95%可信区间 1.570 至 4.242；P<0.001）、影像学肿瘤直径<25.5mm（OR 6.566，95%可信区间 4.010 至 10.751；P<0.001）和胰体/尾定位（OR 1.908，95%可信区间 1.119 至 3.253；P=0.018）是潜在过度治疗的独立预测因素。影像学肿瘤大小是潜在治疗不足的唯一独立决定因素（OR 0.291，95%可信区间 0.107 至 0.791；P=0.016）。接受潜在治疗不足的患者无病生存率（P<0.001）、总生存率（P<0.001）和疾病特异性生存率（P<0.001）明显较差。
近三分之一接受无功能性胰腺神经内分泌肿瘤手术的患者存在潜在过度治疗。肿瘤直径是唯一能够预测潜在过度和不足手术风险的变量。
