Irfan Ahmer, McElroy Katherine E, Zheng-Pywell Rui, Gillis Andrea, Reddy Sushanth, Yates Clayton, Chen Herbert, Rose J Bart
The Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue S, Birmingham, AL, 35233, USA.
Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA.
Am J Surg. 2025 Feb;240:116116. doi: 10.1016/j.amjsurg.2024.116116. Epub 2024 Dec 1.
Pancreatic neuroendocrine tumors (pNETs) are slow growing, malignant tumors that show different survival outcomes by race. Current size-based guidelines were largely developed in White patients. Our aim was to investigate tumor size and incidence of lymph node metastasis (LNM) between White and Asian pNET patients to evaluate generalizability of established guidelines.
Using the National Cancer Database (NCDB), we conducted a multi-institutional analysis of patients with low grade, resected, nonfunctional, sporadic, non-metastatic pNETs. Chi-squared tests were implemented to determine correlation between PTS and LMN incidence as well as race and LMN incidence. A logistic regression model was utilized to determine correlation between LMN, tumor size, and race. Overall survival was assessed using the Kaplan-Meier method.
A total of 4977 pNET patients (205 Asian and 4772 White) were included in our analysis. Asian patients presented with smaller tumors (3.0 cm vs 3.9 cm, p = 0.029) but when grouped by size, there was no difference in the distribution (p = 0.77). White patients demonstrated a higher incidence of lymph node metastasis at presentation compared to Asian patients (27 % vs 19 %, p = 0.013), a higher likelihood of an R0 resection (95.3 % vs. 89.3 %, p < 0.0001). Within both populations, tumor size (<2 cm, 2-3 cm, and ≥3 cm) positively correlated with incidence of LNM (11.5 %, 24.6 %, and 39.1 %). No difference of LNM was seen between racial cohorts at PTS <3 cm, however, Asian patients were less likely to exhibit LNM at PTS ≥3 cm (28.2 % and 39.5 %, p = 0.04). Overall survival was not significantly different between racial groups (p = 0.92).
Size based surgical resection guidelines for pancreatic neuroendocrine tumors based on a predominantly White patient population may not be generalizable to the Asian population. Within this population, we found the risk of lymph node metastasis did not increase at similar rates with increasing primary tumor size.
胰腺神经内分泌肿瘤（pNETs）是生长缓慢的恶性肿瘤，其生存结果因种族而异。当前基于肿瘤大小的指南主要是在白人患者中制定的。我们的目的是调查白人及亚洲pNET患者的肿瘤大小及淋巴结转移（LNM）发生率，以评估现有指南的普适性。
利用国家癌症数据库（NCDB），我们对低级别、已切除、无功能、散发性、非转移性pNETs患者进行了多机构分析。采用卡方检验确定肿瘤大小与LNM发生率以及种族与LNM发生率之间的相关性。利用逻辑回归模型确定LNM、肿瘤大小和种族之间的相关性。采用Kaplan-Meier法评估总生存期。
我们的分析共纳入4977例pNET患者（205例亚洲患者和4772例白人患者）。亚洲患者的肿瘤较小（3.0厘米对3.9厘米，p = 0.029），但按大小分组时，分布无差异（p = 0.77）。与亚洲患者相比，白人患者就诊时淋巴结转移发生率更高（27%对19%，p = 0.013），R0切除的可能性更高（95.3%对89.3%，p < 0.0001）。在这两个人群中，肿瘤大小（<2厘米、2 - 3厘米和≥3厘米）与LNM发生率呈正相关（11.5%、24.6%和39.1%）。在肿瘤大小<3厘米时，不同种族队列的LNM无差异，然而，亚洲患者在肿瘤大小≥3厘米时发生LNM的可能性较小（28.2%和39.5%，p = 0.04）。不同种族组的总生存期无显著差异（p = 0.92）。
基于主要为白人患者群体制定的胰腺神经内分泌肿瘤的基于大小的手术切除指南可能不适用于亚洲人群。在该人群中，我们发现随着原发肿瘤大小增加，淋巴结转移风险的增加速率并不相同。
