Impact and Clinical Predictors of Lymph Node Metastases in Nonfunctional Pancreatic Neuroendocrine Tumors  

作　　者：Yu Jiang Jia-Bin Jin Qian Zhan Xia-Xing Deng Bai-Yong Shen 

机构地区：[1]Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, China

出　　处：《Chinese Medical Journal》2015年第24期3335-3344,共10页中华医学杂志（英文版）

摘　　要：Background： The optimal surgical management of nonfunctional pancreatic neuroendocrine tumors （NF-PNETs） is still controversial. Here, we evaluated the impact of lymph node status on postoperative recurrence in patients with NF-PNET and the potential of preoperative variables for predicting lymph node metastasis （LNM）. Methods： In this mono-institutional retrospective cohort study conducted in 100 consecutive patients who underwent NF-PNET resection between January 2004 and December 2014, we evaluated risk factors for survival using the Kaplan-Meier method and the Cox regression model. Predictors of LNM were evaluated using the logistic regression model, and the power of predictive models was evaluated using receiver operating characteristic curve analysis. Results： Five-year disease-free survival of resected NF-PNET was 64.1%. LNM was independently associated with postoperative recurrence （hazard ratio = 3.995, P = 0.003）. Multivariate analysis revealed tumor grade as an independent factor associated with LNM （G2 vs. G I ： odds ratio [OR] =6.287, P- 0.008; G3 vs. G 1： OR = 12.407, P = 0.001）. When tumor grade was excluded, radiological tumor diameter 〉2.5 cm （OR = 5.430, P = 0.013） and presence of symptoms （OR = 3.366, P = 0.039） were significantly associated with LNM. Compared to neoplasms with radiological diameter 〉2.5 cm （32.1%）, tumors ≤2.5 cm had an obviously lower risk of LNM （7.7%）, indicating the reliability of this parameter in predicting LNM （area under the curve, 0.693）. Incidentally discovered NF-PNETs ≤2.5 cm were associated with a low-risk of LNM and excellent survival. Conclusions： LNM is significantly associated with postoperative recurrence. Radiological tumor diameter is a reliable predictor of LNM in NF-PNETs. Our results indicate that lymphadenectomy in small （≤2.5 cm） NF-PNETs is not routinely necessary.Background： The optimal surgical management of nonfunctional pancreatic neuroendocrine tumors （NF-PNETs） is still controversial. Here, we evaluated the impact of lymph node status on postoperative recurrence in patients with NF-PNET and the potential of preoperative variables for predicting lymph node metastasis （LNM）. Methods： In this mono-institutional retrospective cohort study conducted in 100 consecutive patients who underwent NF-PNET resection between January 2004 and December 2014, we evaluated risk factors for survival using the Kaplan-Meier method and the Cox regression model. Predictors of LNM were evaluated using the logistic regression model, and the power of predictive models was evaluated using receiver operating characteristic curve analysis. Results： Five-year disease-free survival of resected NF-PNET was 64.1%. LNM was independently associated with postoperative recurrence （hazard ratio = 3.995, P = 0.003）. Multivariate analysis revealed tumor grade as an independent factor associated with LNM （G2 vs. G I ： odds ratio [OR] =6.287, P- 0.008; G3 vs. G 1： OR = 12.407, P = 0.001）. When tumor grade was excluded, radiological tumor diameter 〉2.5 cm （OR = 5.430, P = 0.013） and presence of symptoms （OR = 3.366, P = 0.039） were significantly associated with LNM. Compared to neoplasms with radiological diameter 〉2.5 cm （32.1%）, tumors ≤2.5 cm had an obviously lower risk of LNM （7.7%）, indicating the reliability of this parameter in predicting LNM （area under the curve, 0.693）. Incidentally discovered NF-PNETs ≤2.5 cm were associated with a low-risk of LNM and excellent survival. Conclusions： LNM is significantly associated with postoperative recurrence. Radiological tumor diameter is a reliable predictor of LNM in NF-PNETs. Our results indicate that lymphadenectomy in small （≤2.5 cm） NF-PNETs is not routinely necessary.

关 键 词：Lymph Node Metastasis Neuroendocrine Tumor Nonfunctional Pancreatic Postoperative Recurrence Tumor Diameter 

分 类 号：S816.7[农业科学—饲料科学] O211.67[农业科学—畜牧学]