对无功能胰腺神经内分泌肿瘤手术适应症充分性的严格评估。

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-07-02 DOI:10.1093/bjsopen/zrae083
Stefano Partelli, Anna Battistella, Valentina Andreasi, Francesca Muffatti, Domenico Tamburrino, Nicolò Pecorelli, Stefano Crippa, Gianpaolo Balzano, Massimo Falconi
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引用次数: 0

摘要

背景:缺乏术前预后因素来准确预测非功能性胰腺神经内分泌肿瘤的侵袭性,可能会导致不恰当的治疗决策。本研究旨在严格评估可切除的非功能性胰腺神经内分泌肿瘤患者手术治疗的适当性,并调查手术适当性的术前特征:对在圣拉斐尔医院(2002-2022年)接受非功能性胰腺神经内分泌肿瘤根治性手术的患者进行了一项回顾性研究。根据侵袭性组织学特征和手术后一年内疾病复发(早期复发)情况,将手术治疗的适当性分为适当治疗、潜在过度治疗和潜在治疗不足:结果:共纳入 384 例患者。结果:共纳入 384 例患者,其中 230 例(60%)接受了适当的手术治疗,其余 154 例(40%)接受了可能不适当的治疗:129人(34%)可能治疗过度,25人(6%)可能治疗不足。手术治疗的适当性与放射学肿瘤大小(P < 0.001)、肿瘤部位(P = 0.012)、手术技术(P < 0.001)和手术切除年份(P < 0.001)显著相关。2015年之前进行的手术(OR 2.580,95% 置信区间:1.570 至 4.242;P <0.001)、放射学肿瘤直径 < 25.5 mm(OR 6.566,95% 置信区间:4.010 至 10.751;P <0.001)和胰体/胰尾定位(OR 1.908,95% 置信区间:1.119 至 3.253;P = 0.018)被认为是潜在过度治疗的独立预测因素。放射学肿瘤大小是潜在治疗不足的唯一独立决定因素(OR 0.291,95% c.i. 0.107 至 0.791;P = 0.016)。潜在治疗不足患者的无病生存期(P < 0.001)、总生存期(P < 0.001)和疾病特异性生存期(P < 0.001)均明显较差:结论:近三分之一接受非功能性胰腺神经内分泌肿瘤手术的患者可能存在过度治疗。肿瘤直径是预测潜在手术过度治疗和治疗不足风险的唯一变量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Critical appraisal of the adequacy of surgical indications for non-functioning pancreatic neuroendocrine tumours.

Background: The lack of preoperative prognostic factors to accurately predict tumour aggressiveness in non-functioning pancreatic neuroendocrine tumours may result in inappropriate management decisions. This study aimed to critically evaluate the adequacy of surgical treatment in patients with resectable non-functioning pancreatic neuroendocrine tumours and investigate preoperative features of surgical appropriateness.

Methods: A retrospective study was conducted on patients who underwent curative surgery for non-functioning pancreatic neuroendocrine tumours at San Raffaele Hospital (2002-2022). The appropriateness of surgical treatment was categorized as appropriate, potential overtreatment and potential undertreatment based on histologic features of aggressiveness and disease relapse within 1 year from surgery (early relapse).

Results: A total of 384 patients were included. Among them, 230 (60%) received appropriate surgical treatment, whereas the remaining 154 (40%) underwent potentially inadequate treatment: 129 (34%) experienced potential overtreatment and 25 (6%) received potential undertreatment. The appropriateness of surgical treatment was significantly associated with radiological tumour size (P < 0.001), tumour site (P = 0.012), surgical technique (P < 0.001) and year of surgical resection (P < 0.001). Surgery performed before 2015 (OR 2.580, 95% c.i. 1.570 to 4.242; P < 0.001), radiological tumour diameter < 25.5 mm (OR 6.566, 95% c.i. 4.010 to 10.751; P < 0.001) and pancreatic body/tail localization (OR 1.908, 95% c.i. 1.119 to 3.253; P = 0.018) were identified as independent predictors of potential overtreatment. Radiological tumour size was the only independent determinant of potential undertreatment (OR 0.291, 95% c.i. 0.107 to 0.791; P = 0.016). Patients subjected to potential undertreatment exhibited significantly poorer disease-free survival (P < 0.001), overall survival (P < 0.001) and disease-specific survival (P < 0.001).

Conclusions: Potential overtreatment occurs in nearly one-third of patients undergoing surgery for non-functioning pancreatic neuroendocrine tumours. Tumour diameter emerges as the sole variable capable of predicting the risk of both potential surgical overtreatment and undertreatment.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
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3.20%
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144
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