A simple morphological classification to estimate the malignant potential of pancreatic neuroendocrine tumors
A simple morphological classification to estimate the malignant potential of pancreatic neuroendocrine tumors
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DOI：
10.1007/s00535-017-1349-7
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发表时间：
2017-10-01
影响因子：
6.3
通讯作者：
Tanabe, Minoru
中科院分区：
文献类型：
--
作者：
Oba, Atsushi;Kudo, Atsushi;Tanabe, Minoru
背景一种新的形态学分类方法使用切除标本预测胰腺神经内分泌肿瘤（P-NETs）患者的恶性潜能和预后。本研究的目的是检查使用非侵入性多探测器计算机断层扫描（MDCT）在P-NETs.Methods的形态学诊断的预测能力2002年至2015年，154例患者被诊断为P-NETs在东京医科齿科大学，82例接受手术治疗的患者被纳入。原发性肿瘤通过MDCT分为三种类型：I型，单纯结节性肿瘤; II型，单纯结节性肿瘤伴结节外生长; III型，融合性多结节性肿瘤。患者由15名临床专家根据分类进行分层，没有任何其他临床或病理信息。结果平均观察时间为1004天。分别有46例、22例和14例患者患有I型、II型和III型肿瘤。形态学分级与肿瘤大小、Ki-67指数和同步肝转移等晚期特征显著相关（均为p < 0.001）。根据ENETS TNM分类（p < 0.001）、AJCC TNM分类（p = 0.046）、WHO 2004分类（p < 0.001）和WHO 2010分类（p < 0.001）判断，所有三种肿瘤类型之间存在显著差异。I型、II型和III型肿瘤患者的5年无进展生存率（PFS）分别为97%、43%和31%（I vs. II，p < 0.001; I vs. III，p < 0.001; II vs. III，p = 0.017）。多因素分析显示II/III型肿瘤和同步肝转移是PFS差的独立危险因素。结论一种新的简单的形态学分类系统可以预测II型和III型肿瘤，这些肿瘤可能比I型肿瘤具有更高的恶性潜能。
Background A novel morphological classification using resected specimens predicted malignant potential and prognosis in patients with pancreatic neuroendocrine tumors (P-NETs). The aim of this study was to examine the predictive ability of morphological diagnoses made using non-invasive multi-detector computed tomography (MDCT) in P-NETs.Methods Between 2002 and 2015, 154 patients were diagnosed with P-NETs at the Tokyo Medical and Dental University, and 82 patients who underwent surgical treatment were enrolled. The primary tumors were classified by MDCT into three types: Type I, simple nodular tumor; Type II, simple nodular tumor with extra-nodular growth; and Type III, confluent multinodular tumor. Patients were stratified by 15 clinical specialists according to classification and without any other clinical or pathological information. Clinicopathological features and patient survival were reviewed retrospectively.Results The mean observation time was 1004 days. Forty-six, 22, and 14 patients had Type I, II, and III tumors, respectively. Morphological classification was significantly correlated with advanced features such as tumor size, Ki-67 index, and synchronous liver metastasis (p < 0.001 for all). There were significant differences between all three tumor types as judged by ENETS TNM classification (p < 0.001), AJCC TNM classification (p = 0.046), WHO 2004 classification (p < 0.001), and WHO 2010 classification (p < 0.001). Five-year progression-free survival (PFS) rates for patients with Type I, II, and III tumors were 97, 43, and 31%, respectively (I vs. II, p < 0.001; I vs. III, p < 0.001; II vs. III, p = 0.017). Multivariate analysis revealed Type II/III tumors and synchronous liver metastasis to be independent risk factors for poor PFS.Conclusion A novel simple morphological classification system would predict Type II and III tumors that may have higher malignant potential than Type I tumors.