[Analysis of clinical and pathological characteristics and prognostic factors in patients with pancreatic neuroendocrine neoplasms].

Abstract

Objective: To analyze the clinical and pathological characteristics of patients with pancreatic neuroendocrine neoplasms (pNEN) and the factors influencing mortality. Methods: Patients with pNEN admitted to the First Affiliated Hospital of Nanjing Medical University between January 2020 and December 2024 were retrospectively included. Clinical data, imaging findings, pathological classification and grading, TNM staging, treatment modalities, and follow-up data were collected, with follow-up until June 30, 2025. The above relevant characteristics of patients with pNEN were analyzed. The Kaplan-Meier method was used to plot survival curves, and multivariate Cox regression model was adppted to identify factors influencing mortality in patients with pNEN. Results: A total of 196 pNEN patients were included, comprising 99 males and 97 females, with age of (55±13) years; There were 169 cases with non-functional pNEN, and 27 cases with functional pNEN (all insulinomas). In imaging examinations, the accuracy rates of CT, MRI, and endoscopic ultrasound (EUS) were 95.9% (187/195), 95.5% (64/67), and 100.0% (59/59), respectively; the pathological positivity rate for EUS-guided fine-needle aspiration biopsy was 89.5% (34/38), 91.8% (180/196) of patients received surgical treatment. In pathological classification and staging, there were 49, 115, and 13 cases of neuroendocrine tumors (NET) graded G1, G2, and G3, respectively, accounting for 25.0%, 58.7%, and 6.6%, respectively; neuroendocrine carcinoma (NEC) and mixed neuroendocrine-non-neuroendocrine tumors (MiNEN) were observed in 16 and 3 cases, respectively, accounting for 8.2% and 1.5%. In TNM staging, there were 58 cases (29.6%) in stage Ⅰ, 77 cases (39.3%) in stage Ⅱ, 29 cases (14.8%) in stage Ⅲ, and 32 cases (16.3%) in stage Ⅳ. In terms of treatment methods, 180 patients (91.8%) underwent surgical treatment, while 16 patients (8.2%) did not undergo surgical treatment. The follow-up duration [M (Q₁, Q₃)] was 38 (25, 49) months, with a total of 27 patients dying, and the median survival time was not reached. Univariate Cox regression analysis indicated that pathological classification and grading as NET G3 (HR=82.95, 95%CI: 22.21-309.75), NEC (HR=189.14, 95%CI: 48.37-739.55) and TNM staging as stage Ⅲ or Ⅳ (HR=0.32, 95%CI: 0.11-0.89) were all factors associated with mortality in pNEN patients. Conclusions: pNEN are most commonly non-functional and classified as NET G2; pathological classification and grade NET G3, NEC, and TNM stages Ⅲ or Ⅳ are factors for mortality in patients with pNEN.