上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

恶性无功能性胰腺神经内分泌肿瘤手术策略与预后

陈旭晓，陈拥军，彭承宏，傅文祎，李勤裕，马 迪，沈柏用   

  1. 上海交通大学 医学院附属瑞金医院普外科，上海 200025
  • 出版日期:2014-10-28 发布日期:2014-10-28
  • 作者简介:陈旭晓（1988-），男，硕士生; 电子信箱: chenxuxiao0902@163.com。

Surgical strategies and prognosis of malignant non-functioning pancreatic neuroendocrine tumors

CHEN Xu-xiao, CHEN Yong-jun, PENG Cheng-hong, FU Wen-yi, LI Qin-yu, MA Di, SHEN Bai-yong   

  1. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2014-10-28 Published:2014-10-28

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摘要：

目的 探讨恶性无功能性胰腺神经内分泌肿瘤（PNETs）的临床病理特点、外科手术方式以及预后相关因素。方法 回顾性分析37例经根治手术治疗的恶性无功能性PNETs患者的临床资料，包括性别、年龄、症状、肿瘤病理特点、手术方式及预后情况。根据手术范围将患者分为2组，即非扩大根治手术组（n=25）和扩大根治手术组（n=12）。2组计量资料比较采用t检验，计数资料比较采用Fisher精确检验，生存分析及单因素分析采用Kaplan-Meier法，组间生存率差异比较采用Log-rank检验，多因素分析采用Cox比例风险模型。结果 37例患者中，男性20例(54%)，女性17例(46%)，年龄28～72岁，中位年龄48岁。21例（57%）肿瘤位于胰头部，16例（43%）肿瘤位于体尾部。根据WHO 2000年PNETs病理分类标准，高分化神经内分泌癌30例（81%），低分化神经内分泌癌3例（8%），混合性外分泌-内分泌癌4例（11%）。2组术后并发症发生率和住院时间差异无统计学意义（P>0.05）。扩大根治手术组累计生存率、无瘤生存率也未显著低于非扩大根治手术组（P>0.05）。多因素分析提示肝转移和Ki67是该组病例的独立预后影响因素。结论 对于有胰周侵犯和肝转移的进展期恶性无功能性PNETs，积极的扩大根治手术是可行和合理的治疗方式。肝转移和Ki67是影响预后的独立危险因素。

关键词: 胰腺神经内分泌肿瘤, 恶性肿瘤, 外科治疗, 生存分析

Abstract:

Objective To investigate the clinical features, pathological characteristics, surgical strategies, and prognostic factors of malignant non-functioning pancreatic neuroendocrine tumors (PNETs). Methods The clinical records of 37 patients with malignant non-functioning PNETs who underwent curative surgery were retrospectively analyzed. The data included sex, age, symptoms, pathological characteristics, surgical strategies, and prognosis. Based on the extent of resection, patients were divided into two groups, i.e. the non-extended resection group (n=25) and extended resection group (n=12). T test was adopted to compare continuous variables. Fisher's exact test was used to compare categorical variables. Kaplan-Meier method was used for survival analysis and univariate analysis. Log-rank test was adopted to evaluate the differences of survival rates of two groups. Multivariate analysis was performed by the Cox regression model. Results Among 37 patients, 20 of them were males (54%) and 17 of them were females (46%). Their age ranged from 28 to 72 years old and the median age was 48 years old. Twenty-one tumors (57%) were located in the head of the pancreas and 16 tumors (43%) were located in body or tail of the pancreas. According to the 2000 WHO classification, there were 30 cases of well-differentiated neuroendocrine carcinomas (81%), 3 cases of poorly differentiated neuroendocrine carcinomas (8%), and 4 cases of mixed exocrine-neuroendocrine carcinomas (11%). The differences of the rate of postoperative complications and hospital stay of two groups were not statistically significant (P>0.05). The cumulative survival and disease-free survival of the extended resection group were not significantly lower than those of the non-extended resection group (P>0.05). The multivariate analysis showed that liver metastases and Ki67 were independent factors that influenced the prognosis of this disease. Conclusion For malignant advanced non-functioning PNETs with peripancreatic invasion or liver metastases, active extended surgery is a reasonable and feasible choice. Liver metastases and Ki67 are independent risk factors that influence the prognosis.

Key words: pancreatic neuroendocrine tumor, malignant tumor, surgical treatment, survival