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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 ›› 2024, Vol. 13 ›› Issue (05) : 607 -614. doi: 10.3877/cma.j.issn.2095-3232.2024.05.003

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微小无功能性胰腺神经内分泌瘤外科治疗进展
王妍1, 李征1, 卓奇峰1, 周陈杰1, 吉顺荣1, 徐晓武1, 陈洁2, 虞先濬1,†()   
  1. 1. 200032　上海复旦大学附属肿瘤医院胰腺外科；200032　复旦大学上海医学院肿瘤学系；200032　上海市胰腺肿瘤研究所；200032　上海，复旦大学胰腺肿瘤研究所
    2. 200032　复旦大学上海医学院肿瘤学系；200032　上海复旦大学附属肿瘤医院头颈及神经内分泌肿瘤内科；200032　上海复旦大学附属肿瘤医院神经内分泌肿瘤中心
  • 收稿日期:2024-05-07 出版日期:2024-10-10
  • 通信作者: 虞先濬
  • 基金资助:
    国家自然科学基金(82141129，82141104); 中国博士后科学基金(2023M730670); 上海市市级科技重大专项(21JC1401500); 上海市教育委员会科技创新项目(2019-01-07-00-07-E00057); 上海市医院发展中心临床研究计划(SHDC2020CR1006A); 上海市科学技术委员会帆船项目(23YF1406900)

Progress in surgical treatment of small nonfunctional pancreatic neuroendocrine tumors

Yan Wang1, Zheng Li1, Qifeng Zhuo1, Chenjie Zhou1, Shunrong Ji1, Xiaowu Xu1, Jie Chen2, Xianjun Yu1,†()   

  1. 1. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, China; Shanghai Institute of Pancreatic Cancer, Shanghai 200032, China; Institute of Pancreatic Cancer, Fudan University, Shanghai 200032, China
    2. Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, China; Department of Head and Neck and Neuroendocrine Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Neuroendocrine Tumor Center, Fudan University Shanghai Cancer Center, Shanghai 200032, China
  • Received:2024-05-07 Published:2024-10-10
  • Corresponding author: Xianjun Yu
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引用本文：

王妍, 李征, 卓奇峰, 周陈杰, 吉顺荣, 徐晓武, 陈洁, 虞先濬. 微小无功能性胰腺神经内分泌瘤外科治疗进展[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 607-614.

Yan Wang, Zheng Li, Qifeng Zhuo, Chenjie Zhou, Shunrong Ji, Xiaowu Xu, Jie Chen, Xianjun Yu. Progress in surgical treatment of small nonfunctional pancreatic neuroendocrine tumors[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 607-614.

胰腺神经内分泌肿瘤是一类起源于神经内分泌细胞和肽能神经元，具有特征性神经内分泌分化的一类异质性肿瘤。从组织病理学角度，可将胰腺神经内分泌肿瘤分为高分化神经内分泌瘤、低分化神经内分泌癌和混合性神经内分泌-非神经内分泌肿瘤；从是否伴有激素分泌引起的临床症状可将胰腺神经内分泌瘤分为功能性和无功能性；根据是否具有致病性基因的胚系突变或缺失，将其分为散发性和遗传性。胰腺神经内分泌瘤发病率和检出率正在增加，这可能与偶然发现的微小无功能性胰腺神经内分泌瘤的诊断数量增加相关，因此该类肿瘤受到了越来越多的关注。然而，目前微小无功能性胰腺神经内分泌瘤的最佳治疗方法仍然存在争议，笔者根据本中心研究成果和临床经验从外科的角度系统地综述了此种肿瘤的诊疗进展。

关键词: 胰腺神经内分泌瘤, 微小, 无功能性, 外科手术, 精准治疗

Pancreatic neuroendocrine neoplasm is a type of heterogeneous tumors with characteristic neuroendocrine differentiation, which is derived from neuroendocrine cells and peptidergic neurons. From the histopathological perspective, pancreatic neuroendocrine neoplasm can be divided into well-differentiated neuroendocrine tumors, lowly-differentiated neuroendocrine cancers and mixed neuroendocrine-non-neuroendocrine neoplasm. Pancreatic neuroendocrine tumors can also be classified into functional and nonfunctional types according to whether they are accompanied by clinical symptoms caused by hormone secretion. According to whether germ-line mutation or deletion of pathogenic genes occurs, pancreatic neuroendocrine neoplasm can be divided into sporadic and hereditary types. The incidence and detection rates of pancreatic neuroendocrine tumors are increasing, which may be associated with the occasionally-detected increase in the diagnostic number of small nonfunctioning pancreatic neuroendocrine tumors. Consequently, this type of tumors has attracted increasing attention. However, the optimal treatment of small nonfunctional pancreatic neuroendocrine tumors remains controversial. Based on the research results and clinical experience of our center, the author systematically reviewed the progress of diagnosis and treatment of this tumor from the perspective of surgery.

Key words: Pancreatic neuroendocrine tumor, Small, Non-functional, Surgical procedures, Precision therapy
表1 微小NF-pNET的淋巴结转移和肝转移风险
数据来源 文献 总例数（例） 微小的定义 微小例数（例） 淋巴结转移率 远处转移率
中国；SEER数据库 Xu等[18] 140；981 直径≤2 cm 42；235 9.52%；12.34% N/A
The National Cancer Data Base Gratian等[7] 1 367 直径≤2 cm 1 367 29% 10%
意大利、荷兰 Pea等[12] 87 直径<3 cm 87 N/A 37%
中国 Zhang等[4] 509 直径≤2 cm 179 6.7% 6.1%
包括澳大利亚等16国 Partelli等[10,16] 500 直径≤2 cm 500 N/A 0.08%
美国 Bolm等[11] 810 直径<3 cm 810 15.8% N/A
SEER数据库 Vega等[17] 612 直径≤2 cm 612 11.7% 5.7%
美国 Dong等[19] 328 直径≤2 cm 328 12.8% N/A
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