FUNCTIONING INSULINOMA - INCIDENCE, RECURRENCE, AND LONG-TERM SURVIVAL OF PATIENTS - A 60-YEAR STUDY
FUNCTIONING INSULINOMA - INCIDENCE, RECURRENCE, AND LONG-TERM SURVIVAL OF PATIENTS - A 60-YEAR STUDY
复制标题
DOI：
10.1016/s0025-6196(12)62083-7
复制
发表时间：
1991-07-01
影响因子：
8.9
通讯作者：
BALLARD, DJ
中科院分区：
文献类型：
--
作者：
SERVICE, FJ;MCMAHON, MM;BALLARD, DJ
从1927年到1986年的60年间，我们评估了梅奥诊所所有组织学证实的功能性胰岛素瘤患者的发病率、复发率和长期生存率。利用梅奥医院完整的医疗记录系统和明尼苏达州奥姆斯特德县居民的综合流行病学数据库，我们发现了224名患者，他们在梅奥医院进行了最初的胰腺检查，确认存在胰岛素瘤。这些患者在手术诊断时的中位年龄（和范围）为47岁（8至82岁），59%为女性患者。在研究期间，奥姆斯特德县居民中发生了8例胰岛素瘤；他们的年龄和性别分布与整个队列相似。在研究期间，奥姆斯特德县居民的胰岛素瘤发病率在过去20年里稳定上升，每100万人年4例。在整个队列中，7.6%患有多发性内分泌肿瘤I型（MEN I）， 5.8%患有恶性胰岛素瘤。MEN I患者的复发风险（10年和20年为21%）高于无MEN I患者（10年和20年为5%和7%）。虽然整个队列的生存率没有明显降低，但恶性胰岛素瘤患者的生存率明显低于预期（术后10年预期生存率为29%，而术后10年预期生存率为88%）。我们的结论是胰岛素瘤并不像以前怀疑的那么罕见。手术切除成功后，MEN I患者胰岛素瘤复发的长期风险相对较高；对于良性疾病的患者，长期生存正常。
For the 60-year period from 1927 through 1986, we assessed the incidence, recurrence, and long-term survival among all Mayo Clinic patients with histologically confirmed functioning insulinoma. With use of the complete medical record system at Mayo and the comprehensive epidemiologic data base of residents of Olmsted County, Minnesota, we found 224 patients in whom an initial pancreatic exploration at Mayo had confirmed the presence of insulinoma. The median age (and range) of these patients at surgical diagnosis was 47 (8 to 82) years, and 59% were female patients. During the study period, eight cases of insulinoma occurred among residents of Olmsted County; their age and gender distributions were similar to those of the total cohort. The incidence of insulinoma among residents of Olmsted County increased during the study period to a stable level during the last 2 decades of 4 cases per 1 million person-years. For the total cohort, 7.6% had multiple endocrine neoplasia type I (MEN I), and 5.8% had malignant insulinoma. The risk of recurrence was greater among patients with MEN I (21% at 10 and 20 years) than in those without MEN I (5% at 10 years and 7% at 20 years). Although survival of the total cohort was not significantly impaired, it was significantly worse than expected for patients with malignant insulinoma (29% versus 88% expected at 10 years postoperatively). We conclude that insulinoma is less rare than previously suspected. After successful surgical removal, the long-term risk of recurrent insulinoma is relatively high in patients with MEN I; for patients with benign disease, the long-term survival is normal.