Is Multifocality an Indicator of Aggressive Behavior in Small Bowel Neuroendocrine Tumors?
Is Multifocality an Indicator of Aggressive Behavior in Small Bowel Neuroendocrine Tumors?
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DOI：
10.1097/mpa.0000000000000911
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发表时间：
2017-10-01
期刊：
影响因子：
2.9
通讯作者：
Howe, James R.
中科院分区：
文献类型：
--
作者：
Choi, Allen B.;Maxwell, Jessica E.;Howe, James R.
目的：许多小肠神经内分泌肿瘤（SBNETs）患者有多灶性肿瘤（MFTs），但在SBNET研究中，MFTs的频率差异很大。目前还不清楚MFTs患者是否比单发SBNETs患者有更严重的疾病进展或更差的临床病程。我们开始确定多灶性和单灶性SBNETs的频率，并比较临床病理因素、生长抑素受体2的表达和生存率。方法：收集179例手术治疗的SBNETs患者的临床病理资料。采用Welch t检验、Wilcoxon检验和Fisher精确检验进行统计学比较。生存率采用Kaplan-Meier法评估。定量聚合酶链反应检测生长抑素受体2的表达，免疫组织化学检测Ki-67的表达。结果：45%的SBNETs患者存在多灶性肿瘤。临床病理因素，如分级、TNM分期、远处转移的存在、平均生长抑素受体2表达、成像方式的成功以及术前和术后激素水平在多灶组和单灶组之间无显著差异。无进展生存期和总生存期也不受多灶性的显著影响。结论：MFTs与单灶性肿瘤的临床病理特征及生存期明显相似。虽然mfts的病因尚不清楚，但mfts患者的临床病程并不比单发SBNETs患者更具侵袭性。
Objectives: Many patients with small bowel neuroendocrine tumors (SBNETs) have multifocal tumors (MFTs), but the frequency of MFTs has varied widely across SBNET studies. It is also unclear whether patients with MFTs have more advanced disease or worse clinical course than do those with unifocal SBNETs. We set out to determine the frequency of multifocal and unifocal SBNETs and compare clinicopathologic factors, somatostatin receptor 2 expression, and survival.Methods: Clinicopathologic variables from 179 patients with surgically managed SBNETs were collected. Statistical comparisons were made using Welch t-test, Wilcoxon test, and Fisher's exact test. Survival was assessed using the Kaplan-Meier method. Somatostatin receptor 2 expression was analyzed by quantitative polymerase chain reaction, and Ki-67 expression by immunohistochemistry.Results: Multifocal tumors were found in 45% of patients with SBNETs. Clinicopathologic factors such as grade, TNM stage, presence of distant metastases, mean somatostatin receptor 2 expression, success of imaging modalities, and preoperative and postoperative hormone levels were not significantly different between multifocal and unifocal groups. Progressionfree survival and overall survival were also not significantly affected by multifocality.Conclusions: Clinicopathologic features and survival of patients with MFTs and unifocal tumors are remarkably similar. Although the etiology ofMFTs is unclear, patientswithMFTs do not have amore aggressive clinical course than patients with unifocal SBNETs.