胰腺神经内分泌肿瘤临床特征分析:附111例报告

Analysis clinical characteristics of pancreatic neuroendocrine tumors:a report of 111 cases

背景与目的:胰腺神经内分泌肿瘤(pNETs)是一种具有恶变潜能的起源于胰岛内分泌细胞的上皮源性肿瘤,在临床上较为罕见。部分肿瘤分泌过量激素,从而引起特定的内分泌综合征。本研究旨在分析pNETs的临床特征、CT及超声内镜(EUS)基本特征,以及各临床特征与预后的相关性,为临床诊疗提供参考。方法:回顾2016年1月1日─2023年5月1日期间中南大学湘雅医院收治的111例pNETs患者的临床资料。所有患者均经手术切除或活检病理确诊。收集患者的一般资料、实验室指标及影像学资料,分析pNETs患者不同临床分期、病理分级的临床特征及影像学特征,以及与预后相关的危险因素。结果:在确诊的111例pNETs患者中,男性53例(47.7%),女性58例(52.3%);平均年龄为(50.54±13.38)岁,其中非功能性pNETs(NF-pNETs)61例(55.0%),功能性pNETs(F-pNETs)50例(45.0%)。临床特征分析显示,中晚期组(Ⅲ/Ⅳ期)患者病理分级更高、肿瘤多无功能以压迫或转移等症状为主,神经元特异性烯醇化酶(NSE)阳性率更高,治疗方式因出现转移则以化疗、生物制剂治疗等非手术治疗为主。根据病理分级,CT特征分析显示,与低级别组(G1/G2)比较,高级别组(G3/NEC)肿瘤形态多不规则、边界欠清以及更易出现淋巴结转移和远处转移(均P<0.05);EUS特征分析显示,高级别组期患者肿瘤长径大于低级别组(P<0.05)。中位随访时间为37个月,回访率为78.37%,共纳入87例行预后相关因素分析,结果显示,治疗方式(手术vs.非手术:HR=0.232,95%CI=0.056~0.969,P=0.045)、病灶形态(不规则vs.规则:HR=7.038,95%CI=2.028~24.427,P=0.002)、NSE(阳性vs.阴性:HR=3.584,95%CI=1.029~12.481,P=0.045)为患者预后的独立危险因素。结论:手术是pNETs的首选治疗方式,F-pNETs手术率高于NF-pNETs。CT及EUS引导下细针穿刺抽吸/活检术(EUS-FNA)为诊断pNETs较为敏感和准确的方法。病灶的形态、治疗方式、NSE有预测患者临床预后的潜能。因此,分析pNETs临床特征、影像学表现有助于综合评估病情,监测疾病进展情况,制定相应诊疗方案,改善预后。

Background&Aims:Pancreatic neuroendocrine tumors(pNETs)are rare epithelial-origin tumors arising from pancreatic islet endocrine cells with malignant potential.Some tumors secrete excessive hormones,leading to specific endocrine syndromes.This study was performed to analyze the clinical characteristics,basic features of CT and endoscopic ultrasonography(EUS),and the correlation between various clinical features and prognosis of pNETs to provide clinical reference.Methods:The clinical data of 111 patients with pNETs treated in Xiangya Hospital,Central South University,from January 1,2016,to May 1,2023,were reviewed.All patients were pathologically confirmed through surgical resection or biopsy.The general information,laboratory indexes,and imaging data of patients were collected.The clinical characteristics,pathological grade,imaging features of pNETs,and risk factors related to prognosis were analyzed.Results:Among the 111 diagnosed pNETs patients,there were 53 males(47.7%)and 58 females(52.3%),with a mean age of(50.54±13.38)years.There were 61 cases(55.0%)of non-functional pNETs(NF-pNETs)and 50 cases(45.0%)of functional pNETs(F-pNETs).Analysis of clinical characteristics revealed that patients in the advanced stage(Ⅲ/Ⅳ)had higher pathological grades,and tumors mostly non-functional,manifesting predominantly through symptoms related to compression or metastasis,higher positivity for neuron-specific enolase(NSE),and non-surgical treatment,such as chemotherapy and biologics,predominated in cases with metastasis.According to the pathological grades,CT feature analysis revealed that,compared to the low-grade group(G1/G2),the high-grade group(G3/NEC)had irregular tumor shapes,unclear borders,and were more prone to lymph node metastasis and distant metastasis(all P<0.05);EUS feature analysis showed that patients in the high-grade group had a greater tumor longitudinal diameter compared to the low-grade group(P<0.05).The median follow-up time was 37 months,with a follow-up rate of 78.37%.A total of 87 cases were included in the analysis of prognosis-related factors,and the results showed that treatment method(surgery vs.non-surgery:HR=0.232,95%CI=0.056-0.969,P=0.045),lesion morphology(irregular vs.regular:HR=7.038,95%CI=2.028-24.427,P=0.002),and NSE(positive vs.negative:HR=3.584,95%CI=1.029-12.481,P=0.045)were independent risk factors for prognosis of patients.Conclusion:Surgery is the preferred treatment for pNETs,with a higher surgical rate for F-pNETs than NF-pNETs.CT and EUS-guided fine-needle aspiration/biopsy(EUS-FNA)are sensitive and accurate methods for diagnosing pNETs.Lesion morphology,treatment method,and NSE have the potential to predict clinical prognosis in patients.Therefore,analyzing the clinical characteristics and imaging features of pNETs is helpful for comprehensive disease assessment,monitoring disease progression,making appropriate diagnosis and treatment plans,and improving prognosis.