无功能胰腺神经内分泌肿瘤20例临床特征分析

Analysis of the clinical features of 20 cases of non-functioning pancreatic neuroendocrine tumors

目的探讨无功能胰腺神经内分泌肿瘤(NF-pNETs)的临床特征,总结其诊断和治疗经验。方法收集南京大学医学院附属鼓楼医院2008年1月至2018年2月共20例经病理证实的NF-pNETs患者的临床资料,并进行回顾性分析,总结其临床特点及诊疗情况。结果20例患者中,无症状患者9例(9/20),主要因体检意外发现,有症状患者11例(11/20),多因非特异性的消化道症状或因肿瘤占位引起的压迫症状就诊,所有患者均未出现内分泌紊乱症状。19例患者接受手术治疗,肿瘤病理分级显示,G1级7例(7/19),G2级12例(12/19)。直径>2 cm者14例,有4例(4/14)出现淋巴结转移,4例(4/14)出现肝转移。直径≤ 2 cm者5例,均无淋巴结及远处转移。结论NF-pNETs临床表现缺乏特异性,影像学检查是重要的诊断方法,手术是治疗NF-pNETs的首选方法,由于大部分直径< 2 cm的无症状的NF-pNETs是良性的且生长缓慢,转移率极低,对这部分患者是否采取手术治疗需慎重考虑,权衡利弊。

Objective To investigate the clinical features of non-functioning pancreatic neuroendocrine tumors and to summarize experiences in the diagnosis and treatment.Methods The clinical pathology and follow-up data of 20 patients with non-functioning pancreatic neuroendocrine tumors treated in Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University,from January 2008 to February 2018 were retrospectively analyzed.Results Among the 20 patients,9 patients (9/20) were asymptomatic,and the tumor was found unexpectedly by physical examination. Eleven patients (11/20) with symptoms were admitted to the hospital due to non-specific gastrointestinal symptoms or compression symptoms caused by tumor space occupying. None of the patients had endocrine disorders. There were nineteen patients who received surgical treatment. According to the grading system,there were 7 patients (7/19) with G1,and 12 patients (12/19) with G2. Among the 14 patients with diameter of tumor greater than 2 cm,there are 4 patients (4/14) with lymph node metastasis,and 4 patients (4/14) with liver metastasis. Five patients with diameter of tumor less than or equal to 2 cm had no distant metastasis.Conclusions NF-pNETs is often with nonspecific symptoms. Imaging examination is an important diagnostic method. Operation is the primary therapy for NF-pNETs. Because most of the small NF-pNETs with no symptoms are benign and grow slowly,and the metastatic rate is very low. It is important to weigh the pros and cons of surgical treatment for these patients.