Ellison E C
Department of Surgery, Ohio State University College of Medicine, Columbus, USA.
Ann Surg. 1995 Oct;222(4):511-21; discussion 521-4. doi: 10.1097/00000658-199522240-00009.
The author analyzed potential survival determinants in gastrinoma to characterize a possible uniform staging system and to determine whether complete surgical resection improves expected survival.
Gastrinoma is an indolent yet malignant neuroendocrine tumor. The associated gastric acid hypersecretion can be controlled medically. Staging of gastrinoma is inconsistent and the role of surgical resection controversial.
Seventy-four patients with gastrinoma with a minimum 5-year follow-up were assessed. Cox's proportional hazards regression model was used to examine the association of risk factors with survival.
The following factors had no effect on survival: age at diagnosis, sex, presence of lymph node metastases, associated multiple endocrine neoplasia, and method of ulcer treatment. The three unique determinants of survival were primary tumor size (relative risk, 1.534; p = 0.0005), liver metastases (relative risk, 2.947; p = 0.0209), and complete surgical resection (relative risk, 0.163; p = 0.0076). On the basis of these risk factors, a uniform staging system is proposed and predictive survival curves developed.
The primary determinants of survival in gastrinoma are the size of the primary tumor and liver metastases. Complete surgical resection reduces mortality, regardless of other factors.
作者分析了胃泌素瘤潜在的生存决定因素，以确定一个可能统一的分期系统，并确定完整的手术切除是否能提高预期生存率。
胃泌素瘤是一种生长缓慢但具有恶性的神经内分泌肿瘤。其相关的胃酸分泌过多可通过药物控制。胃泌素瘤的分期并不一致，手术切除的作用也存在争议。
对74例胃泌素瘤患者进行了评估，这些患者的随访时间至少为5年。采用Cox比例风险回归模型来检验危险因素与生存之间的关联。
以下因素对生存无影响：诊断时的年龄、性别、淋巴结转移情况、是否伴有多发性内分泌腺瘤病以及溃疡治疗方法。生存的三个独立决定因素是原发肿瘤大小（相对风险，1.534；p = 0.0005）、肝转移（相对风险，2.947；p = 0.0209）以及完整的手术切除（相对风险，0.163；p = 0.0076）。基于这些危险因素，提出了一个统一的分期系统并绘制了预测生存曲线。
胃泌素瘤生存的主要决定因素是原发肿瘤大小和肝转移情况。无论其他因素如何，完整的手术切除均可降低死亡率。
