Pancreatic endocrine tumors: improved TNM staging and histopathological grading permit a clinically efficient prognostic stratification of patients
Pancreatic endocrine tumors: improved TNM staging and histopathological grading permit a clinically efficient prognostic stratification of patients
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DOI：
10.1038/modpathol.2010.58
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发表时间：
2010-06-01
期刊：
影响因子：
7.5
通讯作者：
Falconi, Massimo
中科院分区：
文献类型：
--
作者：
Scarpa, Aldo;Mantovani, William;Falconi, Massimo
胰腺内分泌肿瘤是一种罕见的疾病，设计一个临床上有效的预后分层是一个主要的临床挑战。本研究旨在评估欧洲神经内分泌肿瘤学会(ENETS)最近提出的基于肿瘤淋巴结转移(TNM)的分期和基于增殖活性的分级是否具有临床价值。对1991年至2005年间经手术病理确诊的274例胰腺内分泌肿瘤患者进行了TNM治疗，最后一次随访是在2007年12月。根据世界卫生组织(WHO)的分类，246例为高分化肿瘤(51例良性，56例不确定行为，139例癌)，28例低分化癌。以Ki67免疫组织化学方法进行分级。生存分析不仅确定了TNM系统的预后价值，还强调了在无淋巴结转移和远处转移的情况下，肿瘤直径>4 cm和浸润性有预后意义。然后适当修改T参数以反映这一弱点。改良TNM分期I、II、III、IV期5年生存率分别为100%、93%、65%和35%。多因素分析显示，TNM分期是死亡的独立预测因素，其中II、III和IV期的死亡风险分别是I期肿瘤的7、29和58倍(P
Pancreatic endocrine tumors are rare diseases and devising a clinically effective prognostic stratification of patients is a major clinical challenge. This study aimed at assessing whether the tumor-node-metastasis (TNM)-based staging and proliferative activity-based grading recently proposed by the European NeuroEndocrine Tumors Society (ENETS) have clinical value. TNM was applied to 274 patients with histologically diagnosed pancreatic endocrine tumors operated from 1991 to 2005, with last follow-up at December 2007. According to World Health Organization (WHO) classification, 246 were well-differentiated neoplasms (51 benign, 56 uncertain behavior, 139 carcinomas) and 28 poorly differentiated carcinomas. Grading was based on Ki67 immunohistochemistry. Survival analysis not only ascertained the prognostic value of the TNM system but also highlighted that in the absence of nodal and distant metastasis, infiltration and tumor dimensions over 4 cm had prognostic significance. T parameters were then appropriately modified to reflect this weakness. The 5-year survival for modified TNM stages I, II, III and IV were 100, 93, 65 and 35%, respectively. Multivariate analysis identified TNM stages as independent predictors of death, in which stages II, III and IV showed a risk of death of 7, 29 and 58 times higher than stage I tumors (P