Enucleation for Sporadic Nonfunctioning Pancreatic Neuroendocrine Tumors Larger than 2 Centimeters Is Associated with Equivalent Morbidity and Survival Compared to Smaller Tumors: A Multi-Institutional Study.

IF 3.2 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Neuroendocrinology Pub Date : 2024-01-01 Epub Date: 2024-08-23 DOI:10.1159/000541078

Elias Karam, Alexandra Nassar, Sara Elkurdi, Guillaume Péré, Thomas Freville, Edouard Wasielewski, Anaïs Palen, Julie Périnel, Jean-Christophe Lifante, Emilie Lermite, Ugo Marchese, Mustapha Adham, Olivier Turrini, Laurent Sulpice, Nicolas Régenet, Nicolas Carrère, Sébastien Gaujoux, François Pattou, Alain Sauvanet

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引用次数: 0

Abstract

Introduction: Nonfunctioning pancreatic neuroendocrine tumor (NF-PanNET) ≤2 cm can be observed or resected. Surgery remains recommended for NF-PanNET >2 cm but its extent, enucleation (EN) versus formal resection, remains controversial.

Methods: Multicentric retrospective cohort of sporadic NF-PanNET patients treated with EN. Short- and long-term outcomes were compared according to tumor size on imaging ≤2 cm versus >2 cm.

Results: 131 patients underwent EN for NF-PanNET, including 103 (79.0%) ≤2 cm and 28 (21.0%) >2 cm (extremes, 4-55 mm). Patients' characteristics were comparable, and tumor characteristics only differed in their diameter. Clavien III-IV complications were similar (18.4% vs. 17.9%, p = 1.00) with one death in NF-PanNET ≤2 cm. Grade B/C pancreatic fistula were comparable (16.5% vs. 10.7%, p = 0.850). In NF-PanNET >2 cm there were more pT2/3 stage tumors (85.7% vs. 21.4%, p < 0.001), similar rates of grade G2/3 tumors (25% vs. 16.5%, p = 0.408) with a median Ki67 of 2 (interquartile range: 1-3), and of lymphovascular and perineural invasions. Lymph node picking was done in 46 (35.1%) patients, with a higher median number of harvested lymph nodes in NF-PanNET >2 cm (4 vs. 3, p = 0.01). All were pN0. R0 resection rate (78.6% vs. 82.5%, respectively; p = 0.670) was equivalent. Five-year overall (100% vs. 99%, p = 0.602) and 10-year disease-free (96% vs. 92%, respectively; p = 0.532) survivals were comparable.

Conclusions: EN for selected NF-PanNET >2 cm carries equivalent morbidity, overall and disease-free survivals compared to those observed with NF-PanNET ≤2 cm.

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对大于 2 厘米的散发性无功能胰腺神经内分泌肿瘤进行去核手术，其发病率和生存率与较小肿瘤相当：一项多机构研究。

导言：小于 2 厘米的非功能性胰腺神经内分泌肿瘤（NF-PanNET）可以观察或切除。2厘米的NF-PanNET仍建议手术治疗，但手术范围、去核（EN）与正式切除仍存在争议：方法：对接受EN治疗的散发性NF-PanNET患者进行多中心回顾性队列研究。结果：131名患者接受了EN治疗：131例NF-PanNET患者接受了EN治疗，其中103例（79.0%）≤2厘米，28例（21.0%）> 2厘米（极值为4-55毫米）。患者的特征具有可比性，肿瘤特征仅在直径上存在差异。Clavien III-IV并发症相似（18.4% vs 17.9%，p= 1.00），NF-PanNET≤2厘米的患者中有一人死亡。B/C级胰瘘的发生率相当（16.5% vs 10.7%，P= 0.850）。在 NF-PanNET > 2 厘米患者中，pT2/3 期肿瘤较多（85.7% vs 21.4%，p<0.001），G2/3 级肿瘤的发生率相似（25% vs 16.5%，p= 0.408），中位 Ki67 为 2（IQR：1-3），淋巴管和神经周围侵犯的发生率也相似。46例（35.1%）患者进行了淋巴结摘取，NF-PanNET > 2厘米患者摘取淋巴结的中位数更高（4对3，p= 0.01）。所有患者均为 pN0。R0切除率（分别为78.6% vs 82.5%；p= 0.670）相当。五年总生存率（100% vs 99%，p= 0.602）和十年无病生存率（分别为96% vs 92%，p= 0.532）相当：结论：与观察到的 NF-PanNET ≤ 2 cm 的情况相比，对选定的 NF-PanNET > 2 cm 进行EN治疗的发病率、总生存率和无病生存率相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroendocrinology 医学-内分泌学与代谢

CiteScore

8.30

自引率

2.40%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Neuroendocrinology'' publishes papers reporting original research in basic and clinical neuroendocrinology. The journal explores the complex interactions between neuronal networks and endocrine glands (in some instances also immunecells) in both central and peripheral nervous systems. Original contributions cover all aspects of the field, from molecular and cellular neuroendocrinology, physiology, pharmacology, and the neuroanatomy of neuroendocrine systems to neuroendocrine correlates of behaviour, clinical neuroendocrinology and neuroendocrine cancers. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research, and special focus editions of topical interest.