PDF(Pubmed)
Abstract：
BACKGROUND: Pancreatic neuroendocrine tumors (PNETs) represent 1-2% of pancreatic tumors, with recent guidelines recommending active surveillance for non-functioning PNETs (NF-PNETs) smaller than 2 cm. However, the management of multiple NF-PNETs, as well as the influence of tumor number on prognosis, remains under-researched.
METHODS: This retrospective study analyzed NF-PNET patients who underwent pancreatic resection at Severance Hospital between February 1993 and August 2023, comparing the characteristics of patients diagnosed with multifocal tumors and those with unifocal tumors. A subgroup analysis of overall survival (OS) and recurrence-free survival (RFS) was performed based on multifocality employing the Kaplan-Meier method and the log-rank test.
RESULTS: Of 187 patients, 169 (90.4%) had unifocal and 18 (9.6%) had multifocal tumors. Multifocal tumors were more likely to be diffusely spread, necessitating more total pancreatectomies (diffuse tumor location: 4.7% in unifocal vs. 38.9% in multifocal cases, p < 0.001; total pancreatectomy: 4.1% in unifocal vs. 33.3% in multifocal cases, p < 0.001). In patients with NF-PNET who underwent the same extent of pancreatic resection, no significant difference in the incidence of complication was observed regardless of multifocality. Moreover, no significant difference in OS was seen between the unifocal and multifocal groups (log-rank test: p = 0.93). However, the multifocal group exhibited a poorer prognosis in terms of RFS compared to the unifocal group (log-rank test: p = 0.004) Hereditary syndrome, tumor grade, size, lymphovascular invasion, and lymph node metastasis were key factors in the recurrence.
CONCLUSIONS: This study\'s findings suggest that the presence of multiple tumors was associated with poorer recurrence-free survival but did not affect long-term survival following surgery. Given the long-term oncologic outcome and quality of life following surgery, resection of tumors over 2 cm is advisable in patients with multifocal PNETs, while a cautious \"wait-and-see\" approach for smaller tumors (under 2 cm) can minimize the extent of resection and improve the quality of life. In cases with only small multifocal NF-PNETs (< 2 cm), immediate resection may not be crucial, but the higher recurrence rate than that in solitary NF-PNET necessitates intensified surveillance.
METHODS: This retrospective study analyzed NF-PNET patients who underwent pancreatic resection at Severance Hospital between February 1993 and August 2023, comparing the characteristics of patients diagnosed with multifocal tumors and those with unifocal tumors. A subgroup analysis of overall survival (OS) and recurrence-free survival (RFS) was performed based on multifocality employing the Kaplan-Meier method and the log-rank test.
RESULTS: Of 187 patients, 169 (90.4%) had unifocal and 18 (9.6%) had multifocal tumors. Multifocal tumors were more likely to be diffusely spread, necessitating more total pancreatectomies (diffuse tumor location: 4.7% in unifocal vs. 38.9% in multifocal cases, p < 0.001; total pancreatectomy: 4.1% in unifocal vs. 33.3% in multifocal cases, p < 0.001). In patients with NF-PNET who underwent the same extent of pancreatic resection, no significant difference in the incidence of complication was observed regardless of multifocality. Moreover, no significant difference in OS was seen between the unifocal and multifocal groups (log-rank test: p = 0.93). However, the multifocal group exhibited a poorer prognosis in terms of RFS compared to the unifocal group (log-rank test: p = 0.004) Hereditary syndrome, tumor grade, size, lymphovascular invasion, and lymph node metastasis were key factors in the recurrence.
CONCLUSIONS: This study\'s findings suggest that the presence of multiple tumors was associated with poorer recurrence-free survival but did not affect long-term survival following surgery. Given the long-term oncologic outcome and quality of life following surgery, resection of tumors over 2 cm is advisable in patients with multifocal PNETs, while a cautious \"wait-and-see\" approach for smaller tumors (under 2 cm) can minimize the extent of resection and improve the quality of life. In cases with only small multifocal NF-PNETs (< 2 cm), immediate resection may not be crucial, but the higher recurrence rate than that in solitary NF-PNET necessitates intensified surveillance.
摘要：
背景：胰腺神经内分泌肿瘤（PNETs）占胰腺肿瘤的1-2％，最近的指南建议对小于2厘米的无功能PNETs（NF-PNETs）进行主动监测。然而,多个NF-PNETs的管理，以及肿瘤数量对预后的影响，研究不足。
方法：这项回顾性研究分析了1993年2月至2023年8月在Severance医院接受胰腺切除术的NF-PNET患者，比较了诊断为多灶性肿瘤和单灶性肿瘤的患者的特征。基于多焦点性，采用Kaplan-Meier方法和对数秩检验，对总生存期（OS）和无复发生存期（RFS）进行了亚组分析。
结果：在187名患者中，169例（90.4%）患有单灶性肿瘤，18例（9.6%）患有多灶性肿瘤。多灶性肿瘤更有可能扩散，需要更多的全胰腺切除术（弥漫性肿瘤位置：单焦和4.7%多病灶病例38.9%,p<0.001；全胰腺切除术：单局部与多病灶病例为33.3%，p<0.001)。在接受相同程度胰腺切除的NF-PNET患者中，无论多病灶,并发症发生率均无显著差异.此外，单灶组和多灶组之间的OS没有显着差异（对数秩检验：p=0.93）。然而,与单灶组相比，多灶组的RFS预后较差（对数秩检验：p=0.004）。肿瘤分级,尺寸,淋巴管浸润,淋巴结转移是复发的关键因素。
结论：本研究结果表明，多发性肿瘤的存在与无复发生存率较差相关，但不影响手术后的长期生存率。鉴于手术后的长期肿瘤学结果和生活质量，多灶性PNETs患者应切除超过2cm的肿瘤，而对于较小的肿瘤（2厘米以下），谨慎的“观望”方法可以最大程度地减少切除范围并改善生活质量。在只有小的多焦点NF-PNETs（<2厘米）的情况下，立即切除可能并不重要,但是，与单独的NF-PNET相比，复发率更高，因此需要加强监测。
方法：这项回顾性研究分析了1993年2月至2023年8月在Severance医院接受胰腺切除术的NF-PNET患者，比较了诊断为多灶性肿瘤和单灶性肿瘤的患者的特征。基于多焦点性，采用Kaplan-Meier方法和对数秩检验，对总生存期（OS）和无复发生存期（RFS）进行了亚组分析。
结果：在187名患者中，169例（90.4%）患有单灶性肿瘤，18例（9.6%）患有多灶性肿瘤。多灶性肿瘤更有可能扩散，需要更多的全胰腺切除术（弥漫性肿瘤位置：单焦和4.7%多病灶病例38.9%,p<0.001；全胰腺切除术：单局部与多病灶病例为33.3%，p<0.001)。在接受相同程度胰腺切除的NF-PNET患者中，无论多病灶,并发症发生率均无显著差异.此外，单灶组和多灶组之间的OS没有显着差异（对数秩检验：p=0.93）。然而,与单灶组相比，多灶组的RFS预后较差（对数秩检验：p=0.004）。肿瘤分级,尺寸,淋巴管浸润,淋巴结转移是复发的关键因素。
结论：本研究结果表明，多发性肿瘤的存在与无复发生存率较差相关，但不影响手术后的长期生存率。鉴于手术后的长期肿瘤学结果和生活质量，多灶性PNETs患者应切除超过2cm的肿瘤，而对于较小的肿瘤（2厘米以下），谨慎的“观望”方法可以最大程度地减少切除范围并改善生活质量。在只有小的多焦点NF-PNETs（<2厘米）的情况下，立即切除可能并不重要,但是，与单独的NF-PNET相比，复发率更高，因此需要加强监测。
