Bader Amanda, Landau Sarah, Hwang Jasmine, Passman Jesse, Lee Major Kenneth, Fraker Douglas, Vollmer Charles, Wachtel Heather
Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA.
Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA.
Surgery. 2025 Jan;177:108835. doi: 10.1016/j.surg.2024.05.051. Epub 2024 Oct 4.
The management of recurrent pancreatic neuroendocrine tumors has changed with improvements in both systemic and locoregional therapies. This study aims to describe the patterns of recurrence and respective treatments and evaluate the changes in multimodality treatment.
This is a single-institution retrospective study of patients diagnosed with a pancreatic neuroendocrine tumor from 2004 to 2022. The primary outcome was time to recurrence. Secondary outcomes included overall survival and therapeutic modality. Time to event probabilities were calculated using the Kaplan-Meier method; probabilities were compared using log-rank tests. Cox proportional hazards multivariable modeling with competing risks yielded subdistribution hazard ratios.
Of 284 patients with a primary pancreatic neuroendocrine tumor, 189 underwent upfront surgical resection and were included in the analysis. Of the 182 patients with a well-differentiated G1 or G2 tumor, 44 patients (24%) experienced a recurrence. Mean time to recurrence was 57 months, with the liver as the most common site (77%, 34/44). On adjusted Cox proportional hazards modeling, only nodal positivity (subdistribution hazard ratio, 4.06; 95% confidence interval, 1.31-12.03, P = .013) was associated with a greater risk of recurrence. There was an increase in adoption of newer liver-directed and systemic therapies in the latter half of the study period, with increased use of therapies such as liver embolization and peptide receptor radionucleotide therapy for recurrences occurring after 2010.
Of the patients with well-differentiated pancreatic neuroendocrine tumors managed with upfront surgical resection, one quarter developed recurrent disease. Nodal positivity was the most significant risk factor for recurrence. The majority of patients received multimodality therapies for recurrent disease.
随着全身治疗和局部区域治疗的改善，复发性胰腺神经内分泌肿瘤的管理发生了变化。本研究旨在描述复发模式和相应治疗方法，并评估多模式治疗的变化。
这是一项单机构回顾性研究，研究对象为2004年至2022年被诊断为胰腺神经内分泌肿瘤的患者。主要结局是复发时间。次要结局包括总生存期和治疗方式。使用Kaplan-Meier方法计算事件发生时间概率；使用对数秩检验比较概率。采用具有竞争风险的Cox比例风险多变量模型得出亚分布风险比。
在284例原发性胰腺神经内分泌肿瘤患者中,189例接受了 upfront 手术切除并纳入分析。在182例高分化G1或G2肿瘤患者中，44例（24%）出现复发。复发的平均时间为57个月，肝脏是最常见的复发部位（77%，34/44）。在调整后的Cox比例风险模型中，只有淋巴结阳性（亚分布风险比，4.06；95%置信区间，1.31-12.03，P = 0.013）与更高的复发风险相关。在研究期的后半段，采用更新的肝脏导向治疗和全身治疗的情况有所增加，2010年后复发时使用肝脏栓塞和肽受体放射性核素治疗等疗法的情况增多。
在接受 upfront 手术切除治疗的高分化胰腺神经内分泌肿瘤患者中,四分之一发生了复发性疾病。淋巴结阳性是复发的最显著危险因素。大多数患者接受了复发性疾病的多模式治疗。
