Izumo Wataru, Higuchi Ryota, Furukawa Toru, Shiihara Masahiro, Uemura Shuichiro, Yazawa Takehisa, Yamamoto Masakazu, Honda Goro
Department of Surgery, Institute of Gastroenterology, Tokyo Womens Medical University, 8-1 Kawada-cho, Tokyo, Shinjuku City, Japan.
Division of Gastroenterological Surgery, Tokyo Womens Medical University Yachiyo Medical Center, Yachiyo City, Chiba, Japan.
Langenbecks Arch Surg. 2024 Dec 16;410(1):8. doi: 10.1007/s00423-024-03563-x.
BACKGROUND/OBJECTIVES: The oncological importance of lymphatic, microvascular, and perineural invasions and their association with outcomes in patients with non-functioning pancreatic neuroendocrine neoplasm (NF-PanNEN) remains unclear. We aimed to investigate the role of these factors in the prognosis of patients with NF-PanNEN.
We retrospectively analyzed 115 patients who underwent curative resection and were pathologically and clinically diagnosed with NF-PanNEN. We evaluated the relationship between clinicopathological factors and recurrence.
Thirty (26%), 38 (33%), and 11 (10%) patients had lymphatic, microvascular, and nerve invasions, respectively. Twenty-one patients (18%) experienced recurrence, with a median time to recurrence of 2.6 years (range: 0.3-8.2). The 3-, 5-, and 10-year recurrence-free survival (RFS) rates were 88.3%, 84.4%, and 79.1%, respectively. In multivariate analyses, World Health Organization Grade G2-3 (vs. G1, hazard ratio (HR): 16.2), T factor T3-4 (vs. T1-2, HR: 5.2), and the presence of microvascular invasion (vs. absence, HR: 5.6) were significant risk factors for RFS. When these risk factors were assigned as risk score of three, one, and one points depending on the HR, the 5-year recurrence rates in patients with risk score groups 0-1 and 2-5 were 98.6% and 53.3%, (P < 0.001). Moreover, only the presence of microvascular invasion significantly increased the likelihood of recurrence within 3 years.
The presence of microvascular invasion is an independent risk factor for recurrence in patients with NF-PanNEN. Our risk scoring system, which includes "the presence of microvascular invasion," may be useful for predicting recurrence.
背景/目的：淋巴管、微血管和神经侵犯在无功能性胰腺神经内分泌肿瘤（NF-PanNEN）患者中的肿瘤学重要性及其与预后的关系仍不明确。我们旨在研究这些因素在NF-PanNEN患者预后中的作用。
我们回顾性分析了115例行根治性切除术且经病理和临床诊断为NF-PanNEN的患者。我们评估了临床病理因素与复发之间的关系。
分别有30例（26%）、38例（33%）和11例（10%）患者存在淋巴管、微血管和神经侵犯。21例（18%）患者出现复发，复发的中位时间为2.6年（范围：0.3 - 8.2年）。3年、5年和10年无复发生存率（RFS）分别为88.3%、84.4%和79.1%。在多因素分析中，世界卫生组织G2 - 3级（与G1级相比，风险比（HR）：16.2）、T分期T3 - 4期（与T1 - 2期相比，HR：5.2）以及微血管侵犯的存在（与无微血管侵犯相比，HR：5.6）是RFS的显著危险因素。当根据HR将这些危险因素分别赋值为3分、1分和1分作为风险评分时，风险评分组0 - 1分和2 - 5分患者的5年复发率分别为98.6%和53.3%（P < 0.001）。此外，仅微血管侵犯的存在显著增加了3年内复发的可能性。
微血管侵犯的存在是NF-PanNEN患者复发的独立危险因素。我们包含“微血管侵犯的存在”的风险评分系统可能有助于预测复发。
