胰腺神经内分泌肿瘤的临床特征与预后分析

Analysis of clinical characteristics and prognosis of pancreatic neuroendocrine neoplasms

目的探讨胰腺神经内分泌肿瘤(pNENs)的临床病理特点、诊治及预后相关影响因素。方法选取徐州医科大学附属医院2011年1月至2017年5月收治的p NENs病人55例,研究病人的一般情况、临床表现、影像学检查、肿瘤大小、手术方式及病理等方面并予以随访,并分析诸因素与预后的关系。结果55例病人中,男性19例,女性36例,男∶女为1∶1.9,年龄范围为13~75岁,平均年龄46岁。55例病人中功能性肿瘤26例(47.27%),无功能性肿瘤29例(52.33%),均行手术治疗;根据WHO 2010版分级标准G1、G2、G3级肿瘤分别为38(69.1%)、9(16.36%)、8(14.55%),根据AJCC 8版TNM分期标准I、Ⅱ、Ⅲ、Ⅳ分别为42(76.36%)、7(12.73%)、1(1.82%)、5(9.1%),其中肝转移4例,腹腔广泛转移1例。49(89.10%)例病人获得随访,随访时间4~75个月,随访病人术后1、3、5年总生存率分别为92.6%、79.6%、75.6%。对影响肿瘤预后的相关因素进行统计学分析,发现TNM分期、手术性质、肿瘤分级、淋巴结及远处转移、血管侵犯与病人的预后相关,其中TNM分期、手术方式为影响病人预后的独立影响因素。结论p NENs临床表现多样,CT与MRI为主要检查手段,确诊需病理诊断,外科手术为主要治疗手段,根治性手术切除可较好改善病人预后。WHO分级、TNM分期能对病人预后进行积极指导,远处及淋巴结转移、血管侵犯提示预后较差。

Objective To investigate the clinicpathological characteristics,diagnosis,treatment and prognosis factors of patients with pancreatic neuroendocrine neoplasms(PNENs).Methods 55 patients with PNENs in the Affiliated Hospital of Xuzhou Medical University between 2011 and 2017 were.The data included age,gender,symptoms,tumor size,pathological grades,TNM staging,treatment and follow up.Results The 55 cases were made up of 19 males and 36 females with the age ranging from 13 to 75 years old(mean age46).Of the 55 PNENs,29(52.33%)nonfunctional tumors.According to the tumor grading criteria(WHO,2010 version),patients with G1,G2 and G3 were 38(69.1%),9(16.36%),8(14.55%).According to the tumor staging criteria(AJCC,2017 version),were42(76.36%),7(12.73%),1(1.82%),5(9.1%),respectively4 cases of liver metastasis and 1 case of extensive abdominal metastasis.49(89.1%)patients got followed-up successfully after surgerysurvival rates in 1,3 and 5 years are 92.6%79.6%75.6%respectively.Univariate analysis revealed that factors such as radical operation,lymph node metastasis,distant metastasis,vascular invasion,TNM staging and pathological grading,were associated with prognosis(P<0.05).TNM staging and operation method were proven to be independent risk factors of survival by multivariate analysis.Conclusion PNENs have multiple clinical manifestations CT and MRI are main inspection methodts definite diagnosis depends on pathology.Surgical operation is the most importnt therapy,radical operation gave the patient a better prognosis.TNM AJCC Eighth Edition of 2017 and WHO pathological classification in 2010 have good predictive abilities on survival The lymph node metastasis,distant metastasis and vascular invasion are closely related to the prognosis of p NENs.