肿瘤出芽与胰腺神经内分泌瘤临床病理的相关性及预后价值分析

Tumor budding is related with clinicopathology and prognosis of pancreatic neuroendocrine tumors

目的探讨肿瘤出芽与胰腺神经内分泌瘤临床病理的相关性及其在判断胰腺神经内分泌瘤患者预后中的价值。方法回顾性分析2010年1月至2016年12月在河南省人民医院行手术切除治疗的105例胰腺神经内分泌瘤患者的临床资料,通过HE染色和免疫组化染色,观察患者病理切片肿瘤出芽情况,采用受试者工作特征曲线(ROC)定义肿瘤出芽个数<10为低级别出芽组,≥10为高级别出芽组,分析其与临床病理及预后之间的关系。结果105例胰腺神经内分泌瘤患者,低级别出芽组70例,高级别出芽组35例。高级别出芽组T分期高、远处淋巴结转移及术前肝脏转移多见、血管侵犯率高、术后复发率高(χ^(2)=9.043,4.286,10.130,12.090,9.260,均P<0.05);多因素COX生存分析提示高级别肿瘤出芽(P=0.018)、肿瘤级别(P=0.026)、术前肝转移(P=0.042)、血管侵犯(P=0.048)是胰腺神经内分泌瘤的独立不良预后因素。结论肿瘤出芽与反映胰腺神经内分泌瘤侵袭性的临床病理指标高度相关,是影响根治术后胰腺神经内分泌瘤患者预后的独立危险因素。

Objective To investigate the value of tumor budding in the clinicopathology and prognosis of pancreatic neuroendocrine tumors.Methods The Cliniccal data of 105 pancreatic neuroendocrine tumor patients underwent resection in Henan Provincial People's Hospital from Jan 2010 to Dec 2016 were retrospectively analyzed.Tumor budding was calculated through hematoxylin-eosin(HE)and immunohistochemical stained slides.Based on the receiver operating characteristic curve(ROC),the number of tumor budding≥10 was defined as the high-grade budding group,and<10 as the low-grade budding group.Multiple analysis was performed to determine the relationship between tumor budding and clinicopathology as well as prognosis.Results High-grade budding group was observed in 35 cases and low-grade group in 70.High-grade budding were more common in tumors with advanced T stage,high risk of lymphatic metastasis,preoperative liver metastasis,vascular invasion and postoperative recurrence(respectively χ^(2)=9.043,4.286,10.130,12.090,9.260,all P<0.05).Multivariate COX regression analysis showed that tumor budding(P=0.018),tumor grade(P=0.026),preoperative liver metastasis(P=0.042),vascular invasion(P=0.048)was independent risk factors predicting poor prognosis.Conclusion Tumor budding is highly correlated with clinicopathological parameters which reflect the aggressiveness of pancreatic neuroendocrine tumor,it is also an important prognostic factor.