Well-differentiated grade 1 and 2 nonfunctioning pancreatic neuroendocrine tumor: Consideration of additional factors to aid treatment decision-making

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-09-19 DOI:10.1016/j.amjsurg.2025.116622

Omid Salehi , Ponnandai Somasundar , N Joseph Espat , Abdul Saied Calvino , Mohammad Ali , Sasha Lightfoot , Steve Kwon

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Abstract

Background

Guidelines for 1–2 cm well-differentiated non-functional pancreatic neuroendocrine tumors (NF-PNET) are broad; observation (OB), enucleation (EN), and pancreatic resection (PR) all viable. The objective is analyzing factors impacting survival between approaches.

Methods

Retrospective analysis of NCDB for 1–2 cm well-differentiated grade 1/2 NF-PNET stratified by approach. Factors predicting survival analyzed using Cox regression.

Results

4023 patients included; 1030 OB, 321 EN, and 2672 PR. EN was associated with improved survival (HR 0.20, 95 %CI 0.08–0.53) and was dependent on negative margins (margin negative: HR 0.12, 95 %CI 0.05–0.34). Positive margins for EN were high (29.7 % EN vs. 3.4 % PR, p < 0.01). Factors influencing margins for EN were pancreatic tail location (OR 0.36, 95 %CI 0.13–0.98) and lymphovascular invasion (OR 5.28, 95 %CI 1.42–19.53). Among PRs, only distal pancreatectomy conferred improved survival (HR 0.53, 95 %CI 0.30–0.92).

Conclusion

Optimal treatment for 1–2 cm well-differentiated NF-PNET should incorporate factors influencing positive margins for EN and resection type for PR.

Abstract Image

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高分化1级和2级无功能胰腺神经内分泌肿瘤：考虑辅助治疗决策的其他因素

背景：1-2厘米高分化非功能性胰腺神经内分泌肿瘤（NF-PNET）的指南是广泛的；观察（OB），去核（EN）和胰腺切除术（PR）均可行。目的是分析不同方法之间影响生存率的因素。方法回顾性分析1 ~ 2 cm高分化1/2 NF-PNET患者的NCDB。使用Cox回归分析预测生存的因素。结果纳入4023例患者；1030 OB， 321 EN和2672 PR。EN与改善的生存率相关（HR 0.20, 95% CI 0.08-0.53），并依赖于阴性切缘（切缘阴性：HR 0.12, 95% CI 0.05-0.34）。EN的阳性利润率很高（29.7% EN vs. 3.4% PR, p < 0.01）。影响EN边缘的因素是胰腺尾部位置（OR = 0.36, 95% CI = 0.13-0.98）和淋巴血管浸润（OR = 5.28, 95% CI = 1.42-19.53）。在pr中，只有远端胰腺切除术提高了生存率（HR 0.53, 95% CI 0.30-0.92）。结论1 ~ 2cm高分化NF-PNET的最佳治疗应综合考虑EN阳性切缘的影响因素和PR切除类型的影响因素。

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

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.