Introduction: There is no consensus on managing non-functioning pancreatic neuroendocrine tumors smaller than 2 cm (NF-PANNETs < 2 cm). Therefore, their treatment remains controversial. The aim of this study, by literature review and meta-analysis, is to establish the best management of NF-PANNETs < 2 cm based on overall survival (OS) and cancer-specific survival (CSS). Materials and Methods: An extensive online search was conducted using the MEDLINE, EMBASE, Google Scholar, Scopus, Web of Science, and Cochrane Central databases. All retrospective and prospective studies were included in this study, comparing the outcomes of surgical management vs. conservative management in patients with NF-PANNETs < 2 cm. The pooled odds ratio and 95% CI for survival were calculated. Results: Six studies were included in the quantitative analysis, with 2708 patients managed operatively and 985 managed conservatively. A pooled analysis of all the data demonstrated increased OS in patients managed operatively compared with those managed conservatively at five years (OR = 1.77, 95% CI: 0.96 to 2.58;p= 0.002). In contrast, the meta-analysis did not demonstrate increased CSS in patients undergoing surgical resection compared with conservative management (OR = 1.01, 95% CI: −5.25 to 7.27;p= 0.56). Furthermore, analysis demonstrated a high heterogeneity for OS (Q = 43.98,p< 0.001, tau2= 0.46, I2= 88.63%) and for CSS (Q = 22.81,p< 0.0001, tau2= 1.72, I2= 91.23%). Conclusion: This systematic review and meta-analysis indicated that surgical management of NF-PANNETs < 2 cm improves overall survival (OS) but does not significantly enhance cancer-specific survival (CSS). There is variability in outcomes among studies, and while surgery may help some patients, the lack of clear CSS benefits and associated risks call for individualized decision-making. Therefore, a conservative approach with active surveillance may be more suitable for low-risk patients.
引言：对于小于2厘米的无功能性胰腺神经内分泌肿瘤（NF-PANNETs < 2 cm）的管理尚无共识，因此其治疗策略仍存在争议。本研究旨在通过文献回顾与荟萃分析，基于总生存期（OS）和癌症特异性生存期（CSS）评估结果，确立NF-PANNETs < 2 cm的最佳管理方案。 材料与方法：通过MEDLINE、EMBASE、Google Scholar、Scopus、Web of Science及Cochrane Central数据库进行全面的在线文献检索。本研究纳入了所有比较NF-PANNETs < 2 cm患者手术治疗与保守治疗结局的回顾性和前瞻性研究，并计算了生存期的合并比值比及其95%置信区间。 结果：定量分析共纳入6项研究，涵盖2708例接受手术治疗的患者和985例接受保守治疗的患者。对所有数据的合并分析显示，手术治疗组患者五年总生存期优于保守治疗组（OR = 1.77，95% CI：0.96–2.58；p = 0.002）。然而，荟萃分析未显示手术切除组患者的癌症特异性生存期较保守治疗组有显著提高（OR = 1.01，95% CI：−5.25–7.27；p = 0.56）。此外，分析显示总生存期（Q = 43.98，p < 0.001，tau² = 0.46，I² = 88.63%）和癌症特异性生存期（Q = 22.81，p < 0.0001，tau² = 1.72，I² = 91.23%）均存在高度异质性。 结论：本系统综述与荟萃分析表明，对NF-PANNETs < 2 cm进行手术治疗可改善总生存期，但未能显著提高癌症特异性生存期。各研究结果存在差异，尽管手术可能使部分患者获益，但由于缺乏明确的癌症特异性生存获益及相关手术风险，治疗决策需个体化。因此，对于低风险患者，采取积极监测的保守管理策略可能更为适宜。
肿瘤(癌症)患者之家