Sena Giuseppe, Currò Giuseppe, Vescio Giuseppina, Ammerata Giorgio, Amaddeo Angela, Rizzuto Antonia
Department of General Surgery, "Renato Dulbecco" Hospital, Viale Europa, 88100 Catanzaro, Italy.
Department of Health Science, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy.
Cancers (Basel). 2025 May 13;17(10):1649. doi: 10.3390/cancers17101649.
There is no consensus on managing non-functioning pancreatic neuroendocrine tumors smaller than 2 cm (NF-PANNETs < 2 cm). Therefore, their treatment remains controversial. The aim of this study, by literature review and meta-analysis, is to establish the best management of NF-PANNETs < 2 cm based on overall survival (OS) and cancer-specific survival (CSS).
An extensive online search was conducted using the MEDLINE, EMBASE, Google Scholar, Scopus, Web of Science, and Cochrane Central databases. All retrospective and prospective studies were included in this study, comparing the outcomes of surgical management vs. conservative management in patients with NF-PANNETs < 2 cm. The pooled odds ratio and 95% CI for survival were calculated.
Six studies were included in the quantitative analysis, with 2708 patients managed operatively and 985 managed conservatively. A pooled analysis of all the data demonstrated increased OS in patients managed operatively compared with those managed conservatively at five years (OR = 1.77, 95% CI: 0.96 to 2.58; = 0.002). In contrast, the meta-analysis did not demonstrate increased CSS in patients undergoing surgical resection compared with conservative management (OR = 1.01, 95% CI: -5.25 to 7.27; = 0.56). Furthermore, analysis demonstrated a high heterogeneity for OS (Q = 43.98, < 0.001, tau = 0.46, I = 88.63%) and for CSS (Q = 22.81, < 0.0001, tau = 1.72, I = 91.23%).
This systematic review and meta-analysis indicated that surgical management of NF-PANNETs < 2 cm improves overall survival (OS) but does not significantly enhance cancer-specific survival (CSS). There is variability in outcomes among studies, and while surgery may help some patients, the lack of clear CSS benefits and associated risks call for individualized decision-making. Therefore, a conservative approach with active surveillance may be more suitable for low-risk patients.
对于直径小于2厘米的无功能性胰腺神经内分泌肿瘤（NF-PANNETs < 2 cm）的管理尚无共识。因此，其治疗仍存在争议。本研究旨在通过文献综述和荟萃分析，基于总生存期（OS）和癌症特异性生存期（CSS）确定NF-PANNETs < 2 cm的最佳管理方法。
使用MEDLINE、EMBASE、谷歌学术、Scopus、科学网和考克兰中央数据库进行广泛的在线搜索。本研究纳入了所有回顾性和前瞻性研究，比较了NF-PANNETs < 2 cm患者手术治疗与保守治疗的结果。计算生存的合并比值比和95%置信区间。
六项研究纳入定量分析，其中2708例患者接受手术治疗，985例接受保守治疗。对所有数据的汇总分析表明，与保守治疗的患者相比，手术治疗的患者在五年时总生存期增加（OR = 1.77，95% CI：0.96至2.58；P = 0.002）。相比之下，荟萃分析未显示手术切除患者与保守治疗相比癌症特异性生存期增加（OR = 1.01，95% CI：-5.25至7.27；P = 0.56）。此外，分析显示总生存期（Q = 43.98，P < 0.001，tau = 0.46，I² = 88.63%）和癌症特异性生存期（Q = 22.81，P < 0.0001，tau = 1.72，I² = 91.23%）存在高度异质性。
本系统评价和荟萃分析表明，NF-PANNETs < 2 cm的手术治疗可改善总生存期（OS），但并未显著提高癌症特异性生存期（CSS）。各研究结果存在差异，虽然手术可能对部分患者有帮助，但缺乏明确的CSS益处及相关风险需要个体化决策。因此，对于低风险患者，积极监测的保守方法可能更合适。
