Prognostic relevance of a novel TNM classification system for upper gastroenteropancreatic neuroendocrine tumors
Prognostic relevance of a novel TNM classification system for upper gastroenteropancreatic neuroendocrine tumors
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DOI：
10.1002/cncr.23549
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发表时间：
2008-07-15
期刊：
影响因子：
6.2
通讯作者：
Wiedenmann, Bertram
中科院分区：
文献类型：
--
作者：
Pape, Ulrich-Frank;Jann, Henning;Wiedenmann, Bertram
背景资料。胃肠胰脏(GEP)系统的神经内分泌肿瘤(Net)是一组罕见但具有挑战性的恶性肿瘤，几乎发生在GEP系统的任何部位。方法在2006年提出了一种新的TNM分类系统，用于高位GEP Net的分期和分级。方法回顾分析了202例来自转诊中心且经组织学证实的前庭神经网络患者的TNM分类系统的预后相关性。根据以往的分类系统和TNM分类对患者进行分类。结果：原发肿瘤分别为胃48例，十二指肠23例，胰腺131例。在观察期内，21%的患者死亡。总的5年和10年生存率分别为75%和%。以前的分类系统区分低级别和高级别恶性网络，但不允许进一步的预后区分。相反，根据Ki-67标记，建议的TNM分类能够显著区分不同的肿瘤分期(I-III期与IV期；P<；.01)和细胞增殖率(I级与2级，P=.04；I级与3级，2级与3级，P<；.01)。COX回归分析证实，III或IV期Net和2级或3级Net患者生存率降低的风险增加。结论目前的结果证实了新提出的前置Net的TNM分类系统的预后相关性，在分期分类和分级系统的亚组中具有统计学意义。因此，新的分类系统为临床实践和研究中的GEP Net的预后分层提供了一个有效而有力的工具。
BACKGROUND. Neuroendocrine tumors (NETs) of the gastroenteropancreatic (GEP) system comprise a rare but challenging group of malignant neoplasms and occur at virtually any site of the GEP system. In 2006, a new TNM classification system was proposed for the staging and grading of upper GEP NETs.METHODS. The prognostic relevance of the TNM classification system was analyzed retrospectively in 202 patients from a referral center with histologically proven foregut NET. Patients were classified according to previous classification systems and the TNM classification. Survival data were acquired and statistical analyses were performed by using log-rank and Cox regression testing.RESULTS. Primary tumors were gastric (n = 48), duodenal (n = 23), and pancreatic (n = 131). During the observation period, 21% of patients died. The overall 5- and 10-year survival rates were 75% and 64%, respectively. Previous classification systems discriminated between low-grade and high-grade malignant NETs but did not allow further prognostic differentiation. In contrast, the proposed TNM classification was able to differentiate significantly between different tumor stages (stages I-III vs stage IV; P < .01) and cellular proliferation rates according to Ki-67 labeling (grade I vs grade 2, P = .04; grade I vs grade 3 and grade 2 vs grade 3, P < .01). Cox regression analysis confirmed an increased risk of reduced survival for patients with stage III or IV NET and grade 2 or 3 NET.CONCLUSIONS. The current results demonstrated the prognostic relevance of the newly proposed TNM classification system for foregut NETs with statistical significance for the subgroups of both the staging classification and the grading system. Thus, the new classification system provides a valid and powerful tool for prognostic stratification of GEP NETs in clinical practice and research.