Prognostic factors in pancreatic endocrine neoplasms: An analysis of 136 cases with a proposal for low-grade and intermediate-grade groups
Prognostic factors in pancreatic endocrine neoplasms: An analysis of 136 cases with a proposal for low-grade and intermediate-grade groups
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DOI：
10.1200/jco.2002.10.030
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发表时间：
2002-06-01
影响因子：
45.3
通讯作者：
Klimstra, DS
中科院分区：
文献类型：
--
作者：
Hochwald, SN;Zee, S;Klimstra, DS
目的：在某些器官（如肺）中，内分泌肿瘤是根据有丝分裂率和坏死进行分类的。本研究的目的是评估胰腺内分泌肿瘤的预后因素，最近治疗在一个单一的institution.Patients和方法：在136例接受手术，1979年至1998年，无病生存期（DFS）和疾病特异性生存期（DSS）的肿瘤大小，有丝分裂率，血管浸润，坏死，转移，核等级的影响进行了测定。病例根据现有的分类系统进一步分组，然后根据有丝分裂率重新分组（每50个高倍视野中有丝分裂< 2个）和坏死结果：单因素分析中与DFS和DSS相关的因素包括：每50个高倍视野中有丝分裂5 2个（P = 0.001，P = 0.002），血管浸润（P = 0.02，P = 0.04），大小：5 2 cm（P = 0.01，P = 0.05），转移（P = 0.0002，P = 0.07），坏死（P = 0.002，P = 0.16），核分级（P = 0.04，P = 0.33）。通过多变量分析，对于DFS，肿瘤坏死和转移的存在保持显著性（分别为P = 0.01，P = 0.04）。对于DSS，只有有丝分裂率是一个预后因素（P = .02）。在18例大腺瘤、8例交界性肿瘤和48例低度恶性癌中，任何组之间的DSS均无显著差异（P = 0.3）。然而，在评估我们新提出的组，DFS和DSS之间的差异低，中级组是非常显着的（P = 0.0007，P = 0.006，分别）。结论：胰腺内分泌肿瘤表现出一系列的生物学行为，并提出良性（大腺瘤）和交界性组包含潜在的侵袭性肿瘤。另一种基于有丝分裂率和坏死的系统与存活率密切相关，而没有特别指定任何组为良性。(C)2002年，美国临床肿瘤学会。
Purpose: In some organs (eg, the lung), endocrine tumors are classified on the basis of mitotic rate and necrosis. The purpose of this study was to evaluate prognostic factors in pancreatic endocrine neoplasms recently treated at a single institution.Patients and Methods: In 136 patients undergoing surgery from 1979 to 1998, the influence on disease-free survival (DFS) and disease-specific survival (DSS) of tumor size, mitotic rate, vascular invasion, necrosis, metastases, and nuclear grade was determined. Cases were further grouped according to an existing proposed classification system and then regrouped on the basis of mitotic rate (< 2 mitoses per 50 high-power fields v higher) and necrosis (present or absent) into low- and intermediate-grade groups.Results: Correlations with DFS and DSS in univariate analysis included :5 2 mitoses per 50 high-power fields (P = .001, P = .002), vascular invasion (P = .02, P = .04), size :5 2 cm (P = .01, P = .05), metastases (P = .0002, P = .07), necrosis (P = .002, P = .16), and nuclear grade (P = .04, P = .33), respectively. By multivariate analysis, for DFS, tumor necrosis and presence of metastases retained significance (P = .01, P = .04, respectively). For DSS, only mitotic rate was a prognostic factor (P = .02). Among the 18 macroadenomas, eight borderline tumors, and 48 low-grade carcinomas, there was no significant difference in DSS between any groups (P = .3). However, in evaluating our newly proposed groups, the differences in DFS and DSS between low- and intermediate-grade groups were highly significant (P = .0007, P = .006, respectively).Conclusion: Pancreatic endocrine neoplasms exhibit a spectrum of biologic behavior, and the proposed benign (macroadenoma) and borderline groups contain potentially aggressive tumors. An alternative system based on mitotic rate and necrosis correlates strongly with survival without specifically designating any group as benign. (C) 2002 by American Society of Clinical Oncology.