Abstract：
Patients with gastroenteropancreatic (GEP) neuroendocrine tumors (NET) often present with advanced disease. Primary tumor resection (PTR) in the setting of unresectable metastatic disease is controversial. Most studies evaluating the impact of PTR on overall survival (OS) have been performed using large population-based databases, with limited treatment related data. This study aims to determine whether PTR improves OS and progression-free survival (PFS) in patients with metastatic well-differentiated GEP-NET. This is a retrospective single-institution study of patients with metastatic well-differentiated GEP-NET between 1978 and 2021. The primary outcome was OS. The secondary outcome was PFS. Chi-squared tests and Cox regression were used to perform univariate and multivariate analyses (MVA). OS and PFS were estimated using the Kaplan-Meier method and log-rank test. Between 1978 and 2021, 505 patients presented with metastatic NET, 151 of whom had well-differentiated GEP-NET. PTR was performed in 31 PNET and 77 SBNET patients. PTR was associated with improved median OS for PNET (136 vs. 61 months, p = .003) and SBNET (not reached vs. 79 months, p<.001). On MVA, only higher grade (HR 3.70, 95%CI 1.49-9.17) and PTR (HR 0.21, 95%CI 0.08-0.53) influenced OS. PTR resulted in longer median PFS for patients with SBNET (46 vs. 28 months, p = .03) and a trend toward longer median PFS for patients with PNET (20 vs. 13 months, p = .07). In patients with metastatic well-differentiated GEP-NET, PTR is associated with improved OS and may be associated with improved PFS and should be considered in a multidisciplinary setting. Future prospective studies are needed to validate these findings.
摘要：
胃肠胰腺（GEP）神经内分泌肿瘤（NET）患者常表现为晚期疾病。在不可切除的转移性疾病的背景下，原发性肿瘤切除术（PTR）存在争议。大多数评估PTR对总生存期（OS）影响的研究都是使用大型基于人群的数据库进行的。治疗相关数据有限。这项研究旨在确定PTR是否改善转移性高分化GEP-NET患者的OS和无进展生存期（PFS）。这是1978年至2021年间转移性高分化GEP-NET患者的回顾性单机构研究。主要结果是OS。次要结果是PFS。使用卡方检验和Cox回归进行单变量和多变量分析（MVA）。OS和PFS使用Kaplan-Meier方法和对数秩检验进行估计。1978年至2021年，505例患者出现转移性NET，其中151人的GEP-NET分化良好。31例PNET和77例SBNET患者进行了PTR。PTR与PNET的中位OS改善相关(136与61个月,p=.003)和SBNET(未达到与79个月,p<.001)。在MVA上，只有较高等级(HR3.70,95CI1.49-9.17)和PTR(HR0.21,95CI0.08-0.53)影响OS。PTR导致SBNET患者的中位PFS更长（46vs.28个月,p=.03），PNET患者的中位PFS趋势更长（20vs.13个月,p=.07）。在转移性高分化GEP-NET患者中，PTR与改善的OS相关，也可能与改善的PFS相关，应在多学科环境中加以考虑。需要未来的前瞻性研究来验证这些发现。
