Background: Patient selection for lymphadenectomy remains a controversial aspect in the treatment of pancreatic neuroendocrine tumors (pNETs), given the growing importance of parenchyma-sparing resections and minimally invasive procedures. Methods: This population-based analysis was derived from the German Cancer Registry Group during the period from 2000 to 2021. Patients with upfront resected non-functional non-metastatic pNETs were included. Results: Out of 5520 patients with pNET, 1006 patients met the inclusion criteria. Fifty-three percent of the patients were male. The median age was 64 ± 17 years. G1, G2, and G3 pNETs were found in 57%, 37%, and 7% of the patients, respectively. Lymph node metastasis (LNM) was present in 253 (24%) of all patients. LNM was an independent prognostic factor (HR 1.79, CI 95% 1.21–2.64,p= 0.001) for disease-free survival (DFS). The 3-, 5-, and 10-year disease-free survival in nodal negative tumors compared to nodal positive was 82% vs. 53%, 75% vs. 38%, and 48% vs. 16%. LNM was present in 5% of T1 tumors, 25% of T2 tumors, and 49% of T3–T4 tumors. In T1 tumors, G1 was the most predominant tumor grade (80%). However, in T2 tumors, G2 and G3 represented 44% and 5% of all tumors. LNM was associated with tumors located in the pancreatic head (p< 0.001), positive resection margin (p< 0.001), tumors larger than 2 cm (p< 0.001), and higher tumor grade (p< 0.001). The multivariable analysis showed that tumor size, tumor grade, and location were independent prognostic factors associated with LNM that could potentially be used to predict LNM preoperatively. Conclusion: LNM is an independent negative prognostic factor for DFS in pNETs. Due to the low incidence of LNM in T1 tumors (5%), parenchyma-sparing surgery seems oncologically adequate in small G1 pNETs, while regional lymphadenectomy should be recommended in T2 or G2/G3 pNETs.
背景：鉴于保留实质的切除术和微创手术日益重要，胰腺神经内分泌肿瘤（pNETs）治疗中淋巴结清扫的患者选择仍存在争议。方法：这项基于人群的分析数据来源于2000年至2021年期间的德国癌症登记组。研究纳入了前期切除的非功能性非转移性pNET患者。结果：在5520例pNET患者中，1006例符合纳入标准。53%的患者为男性，中位年龄为64±17岁。G1、G2和G3级pNETs分别占57%、37%和7%。253例（24%）患者存在淋巴结转移（LNM）。LNM是无病生存期（DFS）的独立预后因素（HR 1.79，95% CI 1.21–2.64，p=0.001）。淋巴结阴性肿瘤与淋巴结阳性肿瘤的3年、5年和10年无病生存率分别为82%对53%、75%对38%以及48%对16%。T1期肿瘤中LNM发生率为5%，T2期为25%，T3–T4期为49%。T1期肿瘤中，G1级占主导地位（80%）；而在T2期肿瘤中，G2和G3级分别占44%和5%。LNM与肿瘤位于胰头（p<0.001）、切缘阳性（p<0.001）、肿瘤大于2厘米（p<0.001）以及更高级别的肿瘤分级（p<0.001）相关。多变量分析显示，肿瘤大小、分级和位置是与LNM相关的独立预后因素，这些因素或可用于术前预测LNM。结论：LNM是pNETs患者DFS的独立不良预后因素。由于T1期肿瘤LNM发生率较低（5%），对于小型G1级pNETs，保留实质的手术在肿瘤学上是适当的；而对于T2期或G2/G3级pNETs，则应推荐进行区域淋巴结清扫。
肿瘤(癌症)患者之家