切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (05) : 435 -438. doi: 10.3877/cma.j.issn.2095-3232.2020.05.009

所属专题： 文献；

临床研究

淋巴结转移在无功能型胰腺神经内分泌肿瘤外科治疗中的意义
许文彦1, 吉顺荣1, 刘文生1, 秦毅1, 徐晓武1,†(), 虞先濬1   
  1. 1. 200032　上海，复旦大学附属肿瘤医院胰腺外科　复旦大学胰腺肿瘤研究所　上海胰腺肿瘤研究所；200032　上海，复旦大学上海医学院肿瘤学系
  • 收稿日期:2020-05-14 出版日期:2020-10-10
  • 通信作者: 徐晓武
  • 基金资助:
    国家自然科学基金杰出青年基金(81625016)

Significance of lymph node metastasis in surgical resection of nonfunctional pancreatic neuroendocrine tumors

Wenyan Xu1, Shunrong Ji1, Wensheng Liu1, Yi Qin1, Xiaowu Xu1,†(), Xianjun Yu1   

  1. 1. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Pancreatic Cancer Institute of Fudan University, Shanghai Pancreatic Cancer Institute, Shanghai 200032, China; Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, China
  • Received:2020-05-14 Published:2020-10-10
  • Corresponding author: Xiaowu Xu
  • About author:
    Corresponding author: Xu Xiaowu, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

许文彦, 吉顺荣, 刘文生, 秦毅, 徐晓武, 虞先濬. 淋巴结转移在无功能型胰腺神经内分泌肿瘤外科治疗中的意义[J]. 中华肝脏外科手术学电子杂志, 2020, 09(05): 435-438.

Wenyan Xu, Shunrong Ji, Wensheng Liu, Yi Qin, Xiaowu Xu, Xianjun Yu. Significance of lymph node metastasis in surgical resection of nonfunctional pancreatic neuroendocrine tumors[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(05): 435-438.

目的

探讨淋巴结转移在无功能型胰腺神经内分泌肿瘤（pNET）外科治疗中的意义。

方法

回顾性分析2010年1月至2018年12月在复旦大学附属肿瘤医院行手术治疗的322例无功能型pNET患者临床资料。其中男131例，女191例；年龄16～77岁，中位年龄52岁。患者均签署知情同意书，符合医学伦理学规定。采用χ2检验分析与患者淋巴结转移有关的临床病理学因素，筛选可能因素进行多因素Logistic回归分析。将患者分为淋巴结转移组和非淋巴结转移组，分析淋巴结转移对患者总生存期（OS）的影响，生存分析比较采用Kaplan-Meier法和Log-rank检验。

结果

本组患者淋巴结转移发生率23.3%（75/322），其中R0切除66例，R1切除9例。单因素分析显示，肿瘤直径> 3 cm、病理分级G3与无功能型pNET患者淋巴结转移相关（χ2=5.361，5.554；P<0.05）。Logistic回归多因素分析显示肿瘤直径> 3 cm和病理分级G3是影响无功能型pNET患者淋巴结转移的独立危险因素（OR=4.196，4.673；95%CI:1.140～15.450,1.377～15.864；P<0.05）。患者术后随访时间2.2～152.8个月，中位随访时间44.1个月。淋巴结转移组和非淋巴结转移组中位OS分别为31.5、47.8个月，两组总生存率差异有统计学意义（χ2=6.093，P<0.05）。

结论

肿瘤直径>3 cm和病理低分化是无功能型pNET患者淋巴结转移的独立危险因素，此类患者预后差，建议行包含区域淋巴结清扫的根治性切除。

关键词: 胰腺肿瘤, 神经内分泌肿瘤, 淋巴结切除术
Objective

To explore the significance of lymph node metastasis in surgical treatments of nonfunctional pancreatic neuroendocrine tumors (pNET).

Methods

Clinical data of 322 patients with nonfunctional pNET undergoing surgery in Fudan University Shanghai Cancer Center from January 2010 to December 2018 were retrospectively analyzed. Among them, 131 patients were male and 191 female, aged 16-77 years with a median age of 52 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The clinicopathological factors related to lymph node metastasis were analyzed by Chi-square test. The potential factors were subjected to multivariate Logistic regression analysis. All patients were divided into the lymph node metastasis and non-lymph node metastasis groups. The effect of lymph node metastasis on patients' overall survival (OS) was analyzed. Survival analysis was performed with Kaplan-Meier method and Log-rank test.

Results

The incidence of lymph node metastasis was 23.3%(75/322), including 66 cases of R0 resection and 9 cases of R1 resection. Univariate analysis showed that tumor diameter >3 cm and pathological grade G3 were significantly correlated with lymph node metastasis in nonfuctional pNET patients (χ2=5.361, 5.554; P<0.05). Multivariate Logistic regression analysis demonstrated that tumor diameter >3 cm and pathological grade G3 were the independent risk factors for lymph node metastasis in nonfunctional pNET patients (OR=4.196, 4.673; 95%CI: 1.140-15.450, 1.377-15.864; P<0.05). The postoperative follow-up was ranged from 2.2 to 152.8 months with a median follow-up time of 44.1 months. The median OS in the lymph node metastasis and non-lymph node metastasis groups was 31.5 and 47.8 months, respectively, and significant difference was observed in OS between two groups (χ2=6.093, P<0.05).

Conclusions

Tumor diameter >3 cm and low differentiation are independent risk factors for lymph node metastasis in nonfunctional pNET patients. The prognosis of these patients is poor. Radical resection including regional lymph node dissection is recommended.

Key words: Pancreatic neoplasms, Neuroendocrine tumors, Lymph node excision
表1 影响无功能型pNET患者淋巴结转移的单因素分析
指标 例数 淋巴结转移（例） χ2值 P值
性别 ? ? 0.005 >0.05
? 男 131 32 ? ?
? 女 191 43 ? ?
年龄 ? ? 0.477 >0.05
? <60岁 229 57 ? ?
? ≥60岁 93 18 ? ?
肿瘤部位 ? ? 0.649 >0.05
? 胰头 130 32 ? ?
? 胰体尾 183 39 ? ?
? 弥漫性 9 4 ? ?
肿瘤直径 ? ? 5.361 <0.05
? ≤3 cm 171 21 ? ?
? >3 cm 151 54 ? ?
病理分级 ? ? 5.554 <0.05
? G1 136 14 ? ?
? G2 157 45 ? ?
? G3 29 16 ? ?
[1]
杨尹默，田孝东．胰腺神经内分泌肿瘤外科治疗原则与进展[J]. 中国实用外科杂志，2019, 39(9):890-893.
[2]
Tirosh A, Mukherjee S, Lack J, et al. Distinct genome-wide methylation patterns in sporadic and hereditary nonfunctioning pancreatic neuroendocrine tumors: pancreatic NET methylome[J]. Cancer, 2019, 125(8):1247-1257.
[3]
Keutgen XM, Kumar S, Gara SK, et al. Transcriptional alterations in hereditary and sporadic nonfunctioning pancreatic neuroendocrine tumors according to genotype[J]. Cancer, 2018, 124(3):636-647.
[4]
郭世伟，金钢．胰腺神经内分泌肿瘤淋巴结清扫价值与争议[J]. 中国实用外科杂志，2019, 39(9):917-921.
[5]
Haugvik SP, Vodák D, Haugom L, et al. Transcriptomic profiling of tumor aggressiveness in sporadic nonfunctioning pancreatic neuroendocrine neoplasms[J]. Pancreas, 2016, 45(8):1196-1203.
[6]
Zaidi MY, Lopez-Aguiar AG, Switchenko JM, et al. A novel validated recurrence risk score to guide a pragmatic surveillance strategy after resection of pancreatic neuroendocrine tumors: an international study of 1006 patients[J]. Ann Surg, 2019, 270(3):422-433.
[7]
郭诗翔，王槐志．胰腺神经内分泌肿瘤诊治进展[J]．中国实用外科杂志，2019, 39(9): 968-971.
[8]
Rinzivillo M, Fazio N, Pusceddu S, et al. Sunitinib in patients with pre-treated pancreatic neuroendocrine tumors: a real-world study[J]. Pancreatology, 2018, 18(2):198-203.
[9]
Zhang Y, Shang L, Zhang PP, et al. Clinicopathological features and prognostic validity of the European Neuroendocrine Tumor Society (ENETS) and American Joint Committee on Cancer (AJCC) 8th staging systems in colonic neuroendocrine neoplasms[J]. Cancer Med, 2019, 8(11): 5000-5011.
[10]
Ricci C, Casadei R, Taffurelli G, et al. Is radical surgery always curative in pancreatic neuroendocrine tumors? a cure model survival analysis[J]. Pancreatology, 2018, 18(3):313-317.
[11]
Triponez F, Sadowski SM, Pattou F, et al. Long-term follow-up of MEN1 patients who do not have initial surgery for small ≤2 cm nonfunctioning pancreatic neuroendocrine tumors, an AFCE and GTE study: Association Francophone de Chirurgie Endocrinienne & Groupe d'Etude des Tumeurs Endocrines[J]. Ann Surg, 2018, 268(1):158-164.
[12]
Li C, Li R, Zhang W. Progress in non-invasive detection of liver fibrosis[J]．Cancer Biol Med, 2018, 15(2):124-136.
[13]
Jutric Z, Grendar J, Hoen HM, et al. Regional metastatic behavior of nonfunctional pancreatic neuroendocrine tumors: impact of lymph node positivity on survival[J]. Pancreas, 2017, 46(7):898-903.
[14]
Gratian L, Pura J, Dinan M, et al. Impact of extent of surgery on survival in patients with small nonfunctional pancreatic neuroendocrine tumors in the United States[J]. Ann Surg Oncol, 2014, 21(11):3515-3521.
[15]
Partelli S, Gaujoux S, Boninsegna L, et a1. Pattern and clinical predictors of lymph node involvement in nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs)[J]. JAMA Surg, 2013, 148(10): 932-939.
[16]
夏雨人，李强．非功能型胰腺神经内分泌肿瘤淋巴结清扫的意义及选择[J]．中华肝胆外科杂志，2019, 25(1):49-52.
[17]
Franko J, Feng W, Yip L, et a1. Non-functional neuroendocrine carcinoma of the pancreas: incidence, tumor biology, and outcomes in 2158 patients[J]. J Gastrointest Surg, 2010, 14(3): 541-548.
[18]
Tsutsumi K, Ohtsuka T, Mori Y, et a1. Analysis of lymph node metastasis in pancreatic neuroendocrine tumors (PNETs) based on the tumor size and hormonal production[J]. J Gastroenterol, 2012, 47(6): 678-685.
[19]
Ferrone CR, Tang LH, Tomlinson J, et a1. Determining prognosis in patients with pancreatic endocrine neoplasms: can the WHO classification system be simplified?[J]. J Clin Oncol, 2007, 25(35): 5609-5615.
[20]
Kaluza B, Milczarczyk A, Ziobrowski I, et al. Qualification of patients to laparoscopic resection of pancreatic neuroendocrine tumors and evaluation of their outcome[J]. Pancreatology, 2017, 17(3):S118.
[21]
Merola E, Pavel ME, Panzuto F, et al. Functional imaging in the follow-up of enteropancreatic neuroendocrine tumors: clinical usefulness and indications[J]. J Clin Endocrinol Metab, 2017, 102(5):1486-1494.
[22]
Cen D, Chen J, Li Z, et al. Prognostic significance of cytokeratin 19 expression in pancreatic neuroendocrine tumor: a meta-analysis[J]. PLoS One, 2017, 12(11): e0187588.
[1] 罗文斌, 韩玮. 胰腺癌患者首次化疗后中重度骨髓抑制的相关危险因素分析及预测模型构建[J]. 中华普通外科学文献(电子版), 2024, 18(05): 357-362.
[2] 马中正, 杨云川, 马翔, 周迟, 丁丁, 霍俊一, 徐楠, 崔培元, 周磊. 胰腺癌双硫死亡相关的lncRNA预后模型的构建及免疫反应研究[J]. 中华普通外科学文献(电子版), 2024, 18(05): 368-376.
[3] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[4] 高一飞, 刘根祥, 孙长华, 周广军. 喉返神经监测在无充气腋窝入路腔镜单侧甲状腺切除+中央区淋巴结清扫术中的应用效果[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 483-486.
[5] 蔡永芹, 王君菊, 张敬敬. 不同下纵隔淋巴结清扫顺序在Siewert Ⅱ型食管胃结合部腺癌中应用效果研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 562-565.
[6] 丁志翔, 于鹏, 段绍斌. 血浆BRAF基因检测对腹腔镜右半结肠癌D3根治术中行幽门淋巴结清扫的指导价值[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 570-573.
[7] 史成宇, 季晓琳, 田莉莹, 张来香. 腹腔镜胰十二指肠切除术中第14c/d组淋巴结清扫在胰头癌中的临床效果研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 430-433.
[8] 翁桂湖, 刘悦泽, 张太平. 胰腺神经内分泌肿瘤治疗进展与争议[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 602-606.
[9] 郭诗翔, 谭明达, 王槐志. 胰头癌淋巴结清扫再思考[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 625-628.
[10] 张昊, 潘卫东. 胰腺癌新辅助化疗后可切除性评估现状及进展[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 629-633.
[11] 周倜, 吴嘉, 韩方, 徐林伟, 张宇华. 新辅助治疗时代胰腺癌淋巴结清扫研究进展[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 634-639.
[12] 王军华, 王锐炫. 胰腺癌新辅助化疗现状和治疗策略[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 640-643.
[13] 魏妙艳, 徐近. 合并远处转移胰腺癌系统性治疗的梳理和展望[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 644-650.
[14] 罗柳平, 吴萌萌, 陈欣磊, 林科灿. 胰腺全系膜切除在胰头癌根治术中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 651-656.
[15] 张瑜, 姜梦妮. 基于DWI信号值构建局部进展期胰腺癌放化疗生存获益预测模型[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 657-664.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号