Ki⁃67增殖指数<55%G3级无功能性胰腺神经内分泌瘤的治疗方式及预后  

Treatment and prognosis of patients of G3 nonfunctional pancreatic neuroendocrine tumors with proliferation index of Ki‑67<55%

作　　者：韩序[1] 许雪峰[1] 吴文川[1] 张磊[1] 王文权[1] 匡天涛[1] 王单松[1] 刘亮[1] 楼文晖[1] 戎叶飞[1] Han Xu;Xu Xuefeng;Wu Wenchuan;Zhang Lei;Wang Wenquan;Kuang Tiantao;Wang Shansong;Liu Liang;Lou Wenhui;Rong Yefei(Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院普通外科,上海200032

出　　处：《中华消化外科杂志》2023年第5期631-635,共5页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82173116)。

摘　　要：目的探讨Ki⁃67增殖指数<55%G3级无功能性胰腺神经内分泌瘤(pNETs)的治疗方式及预后。方法采用回顾性描述性研究方法。收集2014年4月至2020年4月复旦大学附属中山医院收治的15例Ki⁃67增殖指数<55%的G3级无功能性pNETs患者的临床病理资料;男11例,女4例;年龄为(58±10)岁。患者均行原发病灶根治性切除术。观察指标:(1)治疗情况。(2)术后病理学特征。(3)随访情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(Q1,Q3)或M(范围)表示,计数资料以绝对数表示。Pearson相关分析验证变量间相关性。Kaplan⁃Meier法绘制生存曲线并计算生存率,Log⁃Rank检验进行生存分析。结果(1)治疗情况。15例无功能性G3级pNETs患者均行胰腺原发灶根治性切除术,其中胰十二指肠切除术5例,胰体尾联合脾切除术10例。5例同时性肝寡转移患者联合行肝段(叶)切除术。15例患者肿瘤切缘均为阴性,手术时间为120(90,210)min,术中出血量为200(50,300)mL;术后30 d内均未发生Clavien⁃Dindo≥Ⅲ级严重并发症。15例患者中,5例行CAPTEM化疗(替莫唑胺联合卡培他滨)为主的综合治疗;2例行局部介入治疗;2例行单纯CAPTEM化疗;行局部介入+分子靶向治疗、局部介入+长效生长抑素类药物治疗、长效生长抑素类药物+分子靶向治疗各1例;3例未行术后治疗。(2)术后病理学特征。15例患者肿瘤最大径为3.3(0.5~6.0)cm,其中2例患者肿瘤最大径<2 cm,13例肿瘤最大径≥2 cm。15例患者清扫淋巴结数目为6(4,10)枚,淋巴结转移数目为2(1,3)枚,其中12例淋巴结转移阳性。15例患者中,肿瘤侵犯胰周邻近脏器5例,同时性肝寡转移5例,神经侵犯和脉管侵犯各8例;病理学TNM分期Ⅱ期、Ⅲ期、Ⅳ期分别为3、7、5例。15例患者原发灶Ki⁃67增殖指数为32%±9%,核分裂象为(11±9)个/10高倍视野,两者无相关性(P>0.05)。(3)随访情况。15例患者均获得术后随访,随访时间Objective To investigate the treatment and prognosis of patients of G3 nonfunctional pancreatic neuroendocrine tumors(pNETs)with proliferation index of Ki‑67<55%.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 15 G3 nonfunctional pNETs patients with proliferation index of Ki‑67<55%who were admitted to Zhongshan Hospital of Fudan University from April 2014 to April 2020 were collected.There were 11 males and 4 females,aged(58±10)years.All patients underwent radical resection of the primary lesion.Observation indicators:(1)treatment;(2)postoperative pathological characteristics;(3)follow‑up.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(Q1,Q3)or M(range).Count data were described as absolute numbers.The Pearson correlation analysis was used to verify the correlation between variables.Kaplan‑Meier method was used to draw survival curve and calculate survival rate.Log‑Rank test was used for survival analysis.Results(1)Treatment.All 15 G3 nonfunctional pNETs patients underwent radical resection of the primary lesion of pancreas,including 5 cases receiving pancreaticoduodenectomy,10 cases receiving distal pancreatectomy with splenectomy.There were 5 patients with simultaneous liver oligometastasis who underwent combined segmental(lobectomy)hepatectomy.All 15 patients had negative tumor margin,and the operation time and volume of intraoperative blood loss of 15 patients was 120(90,210)minutes and 200(50,300)mL,respectively.None of patient had complications≥Ⅲgrade of the Clavien‑Dindo classification during the postoperative 30 days.Of the 15 patients,there were 5 cases receiving comprehensive treatment based on CAPTEM chemotherapy(temozolomide combined with capecitabine),2 cases receiving local interventional therapy,2 cases receiving CAPTEM chemotherapy,1 case receiving local interventional therapy combined with molecular targeted therapy,1 case receiving local interv

关 键 词：胰腺肿瘤 神经内分泌瘤 G3级 无功能性 外科手术 综合治疗 预后 

分 类 号：R735.9[医药卫生—肿瘤]