Introduction: The prognosis and impact of different prognostic factors in pancreatic neuroendocrine neoplasms (pNEN) remain controversial. Aim: To investigate prognostic factors for recurrence-free survival and disease-specific survival in patients with pNEN, divided into three groups: patients undergoing surveillance (tumor size < 2 cm, group 1), patients followed after curative-intended surgery (group 2), and patients with unresectable disease or residual tumors after resection (group 3). Method: A single-center retrospective study including consecutive patients over a 20-year period. Multivariate Cox regression analyses were performed to identify risk factors. Results: 413 patients were included, with a mean (SD) age of 62 ± 14 years. In group 1 (n = 51), median (IQR) follow-up was 29 (21–34) months, and tumor size was 1.0 (0.8–1.4) cm. One progressed and had a tumor resection. In group 2 (n = 165), follow-up 59 (31–102) months, median tumor size 2 (1.2–3.4) cm, median Ki-67 index 5 (3–10)%, the 5-year recurrence rate was 21%. Tumor size (p< 0.001), Ki-67 index (p= 0.02), and location in the pancreatic head (p< 0.001) were independent risk factors. In group 3 (n = 197), follow-up 19 (6–46) months, median tumor size 4.2 (2.6–7.0) cm, Ki-67 index 17 (9–64)%, the median disease-specific survival was 22 (6–75) months—99 in NET G1; 54 in NET G2; 14 in NET G3; and 6 months in neuroendocrine carcinomas (NEC). Age (p= 0.029), plasma chromogranin A (p= 0.014), and proliferation, expressed by grade (p= 0.001) and Ki-67 index (p< 0.001), were risk factors. Conclusion: Growth in pNET < 2 cm requiring surgery was observed in 1/51. Tumor size, Ki-67 index, and location in the head were prognostic factors for disease recurrence, while age, plasma chromogranin A, and proliferation predicted mortality in patients with unresectable disease or residual tumors after resection.
引言：胰腺神经内分泌肿瘤（pNEN）的预后及其不同预后因素的影响仍存在争议。目的：探讨pNEN患者无复发生存期和疾病特异性生存期的预后因素，将患者分为三组：接受监测的患者（肿瘤大小<2厘米，第1组）、根治性手术后随访的患者（第2组）以及无法切除或切除后残留肿瘤的患者（第3组）。方法：一项单中心回顾性研究，纳入连续20年间的患者。采用多变量Cox回归分析确定风险因素。结果：共纳入413例患者，平均（标准差）年龄为62±14岁。第1组（n=51）的中位随访时间为29（21-34）个月，肿瘤大小为1.0（0.8-1.4）厘米。其中1例病情进展并接受了肿瘤切除术。第2组（n=165）的随访时间为59（31-102）个月，中位肿瘤大小为2（1.2-3.4）厘米，中位Ki-67指数为5（3-10）%，5年复发率为21%。肿瘤大小（p<0.001）、Ki-67指数（p=0.02）和胰头位置（p<0.001）是独立的危险因素。第3组（n=197）的随访时间为19（6-46）个月，中位肿瘤大小为4.2（2.6-7.0）厘米，Ki-67指数为17（9-64）%，中位疾病特异性生存期为22（6-75）个月——NET G1为99个月；NET G2为54个月；NET G3为14个月；神经内分泌癌（NEC）为6个月。年龄（p=0.029）、血浆嗜铬粒蛋白A（p=0.014）以及分级（p=0.001）和Ki-67指数（p<0.001）表达的增殖是危险因素。结论：在<2厘米的pNET中，观察到1/51的患者需要手术治疗。肿瘤大小、Ki-67指数和胰头位置是疾病复发的预后因素，而年龄、血浆嗜铬粒蛋白A和增殖情况则预测了无法切除或切除后残留肿瘤患者的死亡率。
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