Intrinsic Contact Between T and N Classifications in Resected Well-Moderately Differentiated Locoregional Pancreatic Neuroendocrine Neoplasms
Intrinsic Contact Between T and N Classifications in Resected Well-Moderately Differentiated Locoregional Pancreatic Neuroendocrine Neoplasms
复制标题
切除的中分化局部胰腺神经内分泌肿瘤中 T 和 N 分类之间的内在联系
DOI：
10.1245/s10434-017-6289-1
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发表时间：
2017
影响因子：
3.7
通讯作者：
Xian-Jun Yu
中科院分区：
文献类型：
--
作者：
Jin-Zhi Xu;Wen-Quan Wang;Shi-Rong Zhang;Hua-Xiang Xu;Chun-Tao Wu;Zi-Hao Qi;He-Li Gao;Quan-Xing Ni;Liang Liu;Xian-Jun Yu
摘要。背景：在胰腺神经内分泌肿瘤（pNENs）的几种预后系统中，N分类的作用存在争议。被广泛接受的改良的欧洲神经内分泌肿瘤学会（mENETS）系统提示这种矛盾可能与T分类有关。方法：回顾性收集监测、流行病学和最终结果（SEER）数据库中的981例患者（1973-2012，队列1）和复旦大学胰腺癌研究所的140例患者（2006-2016，队列2）的数据。所有患者均切除了分化良好至中度的局部区域性pNENs，因此采用了mENETS系统。分析N1分型的相关因素及N与T分型的相关性，并评估基于T分型的N分型预后。结果：在队列1和队列2中，作为T分型的肿瘤大小（2 ~ 4 cm: p < 0.001和p = 0.012）和肿瘤向胰腺外扩散（p < 0.001和p = 0.016）影响N1分型。对于局限于胰腺的肿瘤，N1分类与肿瘤大小相关（分别为p < 0.001和p = 0.046），并预测较差的疾病特异性生存（DSS），而对于扩展到胰腺以外的肿瘤，N1分类不影响患者的预后。结论：N分类与T分类相关，限制了N1分类在pNENs肿瘤-淋巴结-转移系统中的价值。需要一种新的风险模型来预测pNENs的预后，并指导临床实践。
Abstract.BACKGROUND: The role of N classification is controversial in several prognostication systems proposed for pancreatic neuroendocrine neoplasms (pNENs). The widely accepted modified European Neuroendocrine Tumor Society (mENETS) system suggests this contradiction may be related to T classification..METHODS: Data were collected retrospectively from 981 patients in the Surveillance, Epidemiology, and End Results (SEER) database (1973-2012; cohort 1) and 140 patients from the Pancreatic Cancer Institute of Fudan University (2006-2016; cohort 2). All patients had resected well- to moderately differentiated locoregional pNENs, whereby the mENETS system was adopted. Factors related to N1 classification and the association between N and T classifications were analyzed, and N classification prognosis based on T classification was assessed..RESULTS: In cohorts 1 and 2, tumor size (2-4 cm: p 4 cm: p < 0.001 and p = 0.012, respectively) and tumors extending beyond the pancreas (p < 0.001 and p = 0.016, respectively), which are factors for T classification, affected N1 classification. For tumors limited to the pancreas, the N1 classification was associated with tumor size (p < 0.001 and p = 0.046, respectively) and predicted poor disease-specific survival (DSS), while for tumors extending beyond the pancreas, the N1 classification did not affect patient outcomes. Findings obtained with data from the SEER database were reproducible with our institutional data..CONCLUSIONS: N classification is associated with T classification, limiting the value of N1 classification for the pNENs tumor-node-metastasis system. A new risk model is necessary to predict patient outcomes and guide clinical practice for the prognosis of pNENs.