胰腺神经内分泌肿瘤101例临床病理特征及预后因素分析

Analysis of clinicopathological characteristics and prognosis in 101 patients with pancreatic neuroendocrine neoplasms

目的 分析术后PNENs临床病理学特点及预后相关因素.方法 回顾性分析手术治疗的PNENs患者101例的临床资料,探讨临床病理特征之间的相互关系及预后因素.Kaplan-Meier法绘制生存函数,Cox回归模型筛选预后因素.结果 101例PNENs患者中男性47例（46.5％）,女性54例（53.5％）,发病年龄19～80岁,中位发病年龄51岁;神经内分泌瘤（NETs）94例（93.1％）,神经内分泌癌（NECs）7例（6.9％）;肿瘤直径0.5～15 cm,平均为3.3 cm;免疫组化嗜铬粒蛋白A（CgA）和突触素（Syn）阳性率分别为89.0％和98.0％;术后分期I、II和IV期患者分别为66例（65.3％）、23例（22.8％）和12例（11.9％）;其中功能性神经内分泌瘤（F-PNENs）34例（33.7％）,非功能性神经内分泌瘤（NF-PNENs）67例（66.3％）.分析显示,F/NF-PNENs在分期、分级、神经侵犯、脉管内瘤栓、CgA阳性率方面差异均有统计学意义（χ2=10.372、18.162、9.699、5.547、4.043,均P＜0.05）.NETs与NECs在分期、神经侵犯、脉管内瘤栓和CgA阳性率等差异均有统计学意义（χ2=11.642、5.254、14.458、5.254,均P＜0.05）.PNENs 5年生存率达84.3％.影响生存的独立预后因素为肿瘤分级.结论 PNENs临床表现多样,手术是主要的治疗手段,肿瘤分级是影响PNENs生存的独立预后因素.

Objective The aim of our study was to describe the clinicopathological characteristics and to evaluate the prognostic factors of postoperative PNENs.Methods The clinicopathological data of 101 postoperative PNENs patients were collected and analyzed retrospectively.We analyzed the clinicopathological characteristics and prognostic factors.The survival analysis was conducted by Kaplan-Meier method and survival analysis was performed by Cox model.Results 101 patients with PNENs were enrolled,including 46.5% male（n=47） and 53.5% female（n=54）,the median age was 51 years old （ranged 19-80）.94 patients（93.1%） with neuroendocrine tumors（NETs）,7 patients（6.9%） with neuroendocrine carcinomas（NECs）.The mean size of tumor was 3.3 cm（ranged 0.5-15）.Immunohistochemistry staining positive rates for chromogranin A （CgA） and synaptophysin （Syn） were 89.0% and 98.0% respectively.Patients were 66 cases （65.3%）,23 cases （22.8%） and 12 cases （11.9%） in TNM stage I,II and IV respectively.34 cases（33.7%） were F-PNENs,and 67 cases（66.3%） were NF-PNENs.Our study demonstrated that there were statistically significant differences between F-PNENs and NF-PNENs in stage,grade,neural and vascular invasion,CgA positive rate（χ2=10.372,18.162,9.699,5.547,4.043,P〈0.05）.Meanwhile,significant differences were found between NETs and NECs in stage,neural and vascular invasion,CgA positive rate（χ2=11.642,5.254,14.458,5.254,P〈0.05）.PNENs had better prognosis,with 5-year survival rate of 84.3%.The independent prognostic factor for survival was grade.Conclusion PNENs are a family of tumors with diversity clinical presentation and prognosis.Surgery is the main treatment method,grade of PNENs is the independent prognostic factor.