Resection of primary tumor site is associated with prolonged survival in metastatic nonfunctioning pancreatic neuroendocrine tumors.
Resection of primary tumor site is associated with prolonged survival in metastatic nonfunctioning pancreatic neuroendocrine tumors.
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DOI：
10.1016/j.surg.2015.05.042
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发表时间：
2016-01
期刊：
影响因子：
3.8
通讯作者：
Kebebew E
中科院分区：
文献类型：
--
作者：
Keutgen XM;Nilubol N;Glanville J;Sadowski SM;Liewehr DJ;Venzon DJ;Steinberg SM;Kebebew E
高达50%的患者出现无功能胰腺神经内分泌肿瘤（NFpNET）的远处转移。目前尚不清楚切除NFpNET和转移瘤患者的原发肿瘤是否有益。我们使用监测、流行病学和最终结果（SEER）数据库来识别NFpNET和远处转移的患者。本研究的主要结局指标是总生存期。我们确定了882例转移性NFpNET患者和生存数据。303例（34%）患者手术切除了原发性肿瘤，其中243例（80%）为I级或II级。接受手术的患者的中位生存期为65个月（95%CI：60-86），而未接受手术的患者为10个月（p<0.0001）。2003年后诊断的患者（n=625，71%）比早期诊断的患者更有可能接受手术（p=0.001）。多变量分析显示，较低的肿瘤分级（p<0.0001）、较年轻的年龄（p<0.0001）、2003年期间或之后的诊断（p=0.0003）、体/尾肿瘤部位（p=0.009）和原发肿瘤部位的手术切除（p<0.0001）与NFpNET和远处转移患者的生存期延长显著相关。这项研究表明，手术切除原发性NFpNET与远处转移患者的生存期延长相关，因此可以被视为该患者人群的额外治疗选择。
Non-functioning pancreatic neuroendocrine tumors (NFpNET) present with distant metastases in up to 50% of patients. It is unknown whether removal of the primary tumor in patients with NFpNET and metastases is beneficial. We used the Surveillance, Epidemiology and End Results (SEER) database to identify patients with NFpNET and distant metastases. The primary outcome measure in this study was overall survival. We identified 882 patients with metastatic NFpNET and survival data. 303 (34%) patients had surgical removal of their primary tumor of which 243 (80%) were grade I or II. Median survival of patients undergoing surgery was 65 (95% CI: 60–86) versus 10 months for those without surgery (p<0.0001). Patients diagnosed after 2003 (n=625, 71%) were more likely to undergo an operation than those diagnosed earlier (p=0.001). Multivariable analysis showed that lower tumor grade (p<0.0001), younger age (p<0.0001), diagnosis during or after 2003 (p=0.0003), tumor site in the body/tail (p=0.009) and surgical resection of the primary tumor site (p<0.0001) were significantly associated with prolonged survival of patients with NFpNET and distant metastases. This study suggests that surgical removal of primary NFpNET is associated with longer survival in patients with distant metastases and could therefore be considered as a additional treatment option in this patient population.