Background: Neuroendocrine tumours (NET) arising from the small bowel are clinically challenging and are often diagnosed at advanced stages. Disease control with surgery alone can be demanding. Multimodal treatment concepts integrating surgery and non-surgical modalities could be of benefit. Method: Retrospective review of consecutive adult patients with SB NET treated at Imperial College Healthcare NHS Trust between 1 January 2010 and 31 December 2019. Data regarding clinicopathological characteristics, treatments, and disease trajectory were extracted and summarised. Overall and progression/recurrence-free survival were estimated at 5 and 10 years. Results: 154 patients were identified, with a median age of 64 years (range 33–87); 135/154 (87.7%) had stage III/IV disease at diagnosis. Surgery was used in 125 individuals (81.2%), typically with either segmental small bowel resection (60.8%) or right hemicolectomy (33.6%) and mesenteric lymphadenectomy for the primary tumour. Systemic and/or liver-directed therapies were used in 126 (81.8%); 60 (47.6%) had more than one line of non-surgical treatment. Median follow-up was 67.2 months (range 3.1–310.4); overall survival at 5 and 10 years was 91.0% (95% CI: 84.9–94.7%) and 82.5% (95% CI: 72.9–88.9%), respectively. Imaging-based median progression-free survival was 42.7 months (95% CI: 24.7 to 72.4); 5-year progression-free survival was 63.4% (95% CI: 55.0–70.6%); 10-year progression-free survival was 18.7% (95% CI: 12.4–26.1). Nineteen patients (12.3%) reached 10 years follow-up without disease recurrence and therefore were considered cured. Conclusions: Most patients with SB NET present in a metastasised stage. Multimodal treatment concepts may be associated with excellent clinical outcomes. Future work should explore optimal approaches to treatment sequencing and patient selection.
背景：小肠来源的神经内分泌肿瘤（NET）在临床上具有挑战性，常于晚期才被确诊。单纯依靠手术实现疾病控制往往较为困难。整合手术与非手术方式的多模式治疗方案可能带来获益。 方法：回顾性分析2010年1月1日至2019年12月31日期间在帝国理工学院医疗保健NHS信托基金连续收治的成年小肠神经内分泌肿瘤患者。提取并总结其临床病理特征、治疗方案及疾病进展轨迹数据。评估5年及10年总生存率与无进展/无复发生存率。 结果：共纳入154例患者，中位年龄64岁（范围33-87岁）；其中135例（87.7%）确诊时已处于III/IV期。125例（81.2%）接受手术治疗，主要术式为小肠节段切除术（60.8%）或右半结肠切除术（33.6%），并对原发灶行肠系膜淋巴结清扫。126例（81.8%）接受全身治疗和/或肝脏定向治疗；其中60例（47.6%）接受过一线以上非手术治疗。中位随访时间67.2个月（范围3.1-310.4个月）；5年与10年总生存率分别为91.0%（95% CI：84.9–94.7%）和82.5%（95% CI：72.9–88.9%）。基于影像学评估的中位无进展生存期为42.7个月（95% CI：24.7–72.4）；5年无进展生存率为63.4%（95% CI：55.0–70.6%）；10年无进展生存率为18.7%（95% CI：12.4–26.1%）。19例患者（12.3%）在10年随访期间未出现疾病复发，可视为临床治愈。 结论：多数小肠神经内分泌肿瘤患者在就诊时已发生转移。多模式治疗方案可能带来优异的临床结局。未来研究应探索治疗顺序优化与患者选择的最佳策略。
Management of Small Bowel Neuroendocrine Tumours: 10 Years’ Experience at a Tertiary Referral Centre
肿瘤(癌症)患者之家