晚期胰腺神经内分泌肿瘤综合治疗

Comprehensive treatment for advanced pancreatic neuroendocrine neoplasm

胰腺神经内分泌肿瘤(pNENs)按分化程度可分为神经内分泌瘤(NET)和神经内分泌癌(NEC),大部分pNENs分化较好,手术切除是惟一的治愈手段,然而>60%的病人确诊时发生转移。对于分化好的pNENs,完整手术切除仍然是首选的治疗手段,必要时可联合射频消融(RFA)提高完整切除率,而对于无法手术切除的病人,生长抑素类似物、干扰素、依维莫司、舒尼替尼以及包括链脲霉素、替莫唑胺为基础的化疗具有一定疗效;分化差的pNENs则主要选择铂类为基础的化疗方案,肝转移者可选择联合肝动脉介入栓塞(TAE)或肝动脉栓塞化疗(TACE)。总的来说包括药物治疗、手术、介入、消融等治疗手段相结合的多学科综合治疗成为晚期pNENs最主要的治疗手段,这些治疗的选择受到肿瘤病理类型、疾病功能状态、转移情况等多种因素影响。如何更好地将这些治疗手段合理的结合在一起发挥各自的作用,从而改善晚期pNENs预后成为临床医生关注一个重要方向。

Pancreatic neuroendocrine neoplasm （pNENs） are divided into well-differentiated （NENs） and poorly differentiated （NEC） categories by degree of differentiation. Most pNENs are well-differentiated. Surgical resection offers the only chance for cnre, but more than 60% of patients are with distant metastasis at diagnosis. For well-differentiated pNENs, complete surgical resection is still the preferred treatment, and radiofrequency ablation （RFA） combined liver resection can improve the rate of complete resection in some cases. For patients with unresectable disease, somatostatin analogues, interferons, everolimus, sunitinib and streptozotocin-based, temozolomide-based chemotherapy have been proved effective. Platinum-based chemotherapy is the first choice for poorly differentiated NEC and TAE or TACE is a good choice for liver metastases. To sum up, multidisciplinary treatment including medication, surgery, TAErFACE, ablation treatment and so on, is the main treatment pattern for advanced pNENs. The choice of the treatments is determined by a variety of factors such as histological type, disease functional status, metastatic situation, etc. How to give a rational arrangement of the treatments to improve the prognosis of advanced pNENs becomes an important issue for clinicians.