胰腺神经内分泌肿瘤的诊断与外科治疗

Diagnosis and surgical treatment of pancreatic neuroendocrine neoplasms

目的探讨胰腺神经内分泌肿瘤（pNENs）的诊治策略及预后影响因素。方法回顾性分析北京大学第一医院2007年1月至2016年12月经病理证实的44例pNENs患者临床资料，采用Kaplan—Meier法分析患者预后影响因素。结果本组患者肿瘤位于胰头、胰体尾者各22例（50．0％）。无功能性pNENs25例（56．8％），功能性pNENs19例（43．2％）。患者肿瘤手术切除40例。其中胰十二指肠切除14例，胰体尾切除20例，肿瘤单纯切除6例。非根治性手术或未手术4例。肿瘤分级1级23例（52．3％），2级15例（34．1％），3级6例（13．6％）；I期23例（52．3％），II期16例（36．4％），III期2例（4．5％），IV期3例（6．8％）。患者总体1、3及5年生存率分别为92．0％、87．0％和72．0％。总生存期（OS）1～119个月，中位生存期119个月。接受根治性手术与否、肿瘤分级、TNM分期、淋巴结转移及远处转移等是影响患者总生存期（OS）的危险因素（P〈0．05）。结论根治性手术切除是pNENs的首选治疗手段。肿瘤分级、TNM分期、淋巴结转移及远处转移等与预后显著相关。

Objective To study the diagnosis, treatment and prognostic factors of pancreatic neuro- endocrine neoplasms （pNENs）. Methods The clinical, pathological and follow-up data of 44 patients with pNENs treated at the Peking University First Hospital from Jan. 2007 to Dec. 2016 were retrospectively studied. Survival analysis was performed with the Kaplan-Meier method. Results There were 21 male and 23 female patients. The mean age was （54.8± 14.0） years. 25 patients had non-functional, while 19 had functional pNENs. Curative resection was performed in 40 patients. Neural invasion and intravascular cancer emboli were found in 7 and 5 patients, respectively. The pathologic data showed that the number of patients with G1, G2, G3 were 23（52.3% ）, 15（34.1% ）, 6（ 13.6% ）, respectively. The number of patients with stage I , !1, HI, and IV were 23（52.3% ）, 16（36.4% ）, 2（4.5% ） and 3（6.8% ）, respectively. The predictive factors on prognosis included curative resection or not, WHO grade, TNM staging, lymph node metastasis and distant metastasis （ P 〈 0.05 ）. Conclusions Curative surgical resection is the first choice of treatment for pNENs. WHO grade, TNM staging, lymph node metastasis and distant metastasis were significantly related to the prognosis of pNENs.