功能和分级对接受肽受体放射性核素治疗的胰腺神经内分泌肿瘤患者生存的影响。
Impact of functionality and grading on survival in pancreatic neuroendocrine tumor patients receiving peptide receptor radionuclide therapy.
作者信息
Mathew Annie, Kersting David, Fendler Wolfgang P, Braegelmann Johanna, Fuhrer Dagmar, Lahner Harald
机构信息
Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
出版信息
Front Endocrinol (Lausanne). 2025 Apr 15;16:1526470. doi: 10.3389/fendo.2025.1526470. eCollection 2025.
BACKGROUND
Peptide receptor radionuclide therapy (PRRT) is a well-established treatment option for neuroendocrine tumors (NET), yet randomized controlled trials have not provided data on its impact on overall survival. The real-world efficacy of PRRT and its association with tumor functionality and grading in pancreatic neuroendocrine tumors (PanNET) remains underexplored.
METHODS
A retrospective analysis of 166 patients with histologically confirmed metastatic PanNET was performed. Subgroup analyses examined progression-free survival (PFS) and overall survival (OS) following PRRT cycles, stratified by tumor grading, tumor functionality and bone metastases.
RESULTS
Of 166 patients, 100 (60.2%) received PRRT with a median of four cycles. In the PRRT cohort, 68% of patients had deceased. PFS after four and eight consecutive cycles was 20 and 18 months, respectively (p=0.4). OS for the entire cohort was 79 months, with patients receiving 4+ cycles of PRRT having an OS of 87 months and those receiving 5+ cycles achieving an OS of 100 months. Patients with grade 1 or 2 tumors had a significantly longer median OS of 97 months compared to 74.5 months for grade 3 tumors (p = 0.0055). There was no significant difference in OS between functioning and non-functioning tumors after PRRT. Patients with bone metastases who received PRRT had a significantly shorter OS than those without (74 vs. 89 months, p = 0.013). In 19% of patients who received PRRT, therapy was discontinued due to progressive disease, toxicity or death.
CONCLUSIONS
Patients receiving extended cycles of PRRT showed improved survival outcomes in metastatic PanNET, particularly in patients with lower tumor grades and without bone metastases. No survival difference was seen between functioning and non-functioning PanNET, while patients with grade 3 tumors and bone metastases had significantly shorter survival despite PRRT.
背景
肽受体放射性核素治疗（PRRT）是神经内分泌肿瘤（NET）一种成熟的治疗选择，但随机对照试验尚未提供其对总生存期影响的数据。PRRT在胰腺神经内分泌肿瘤（PanNET）中的实际疗效及其与肿瘤功能和分级的关系仍未得到充分研究。
方法
对166例经组织学确诊的转移性PanNET患者进行回顾性分析。亚组分析检查了PRRT周期后的无进展生存期（PFS）和总生存期（OS），并按肿瘤分级、肿瘤功能和骨转移进行分层。
结果
166例患者中，100例（60.2%）接受了PRRT，中位周期数为4个周期。在PRRT队列中，68%的患者已经死亡。连续4个和8个周期后的PFS分别为20个月和18个月（p = 0.4）。整个队列的OS为79个月，接受4个以上周期PRRT的患者OS为87个月，接受5个以上周期PRRT的患者OS为100个月。1或2级肿瘤患者的中位OS显著更长，为97个月，而3级肿瘤患者为74.5个月（p = 0.0055）。PRRT后，功能性和非功能性肿瘤的OS无显著差异。接受PRRT的骨转移患者的OS明显短于无骨转移患者（74个月对89个月，p = 0.013）。在接受PRRT的患者中，19%因疾病进展、毒性或死亡而停止治疗。
结论
接受延长周期PRRT的转移性PanNET患者生存结局有所改善，尤其是肿瘤分级较低且无骨转移的患者。功能性和非功能性PanNET之间未观察到生存差异，而3级肿瘤和骨转移患者尽管接受了PRRT，但其生存期仍显著缩短。
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