Surgical Treatment as a Principle for Patients with High-Grade Pancreatic Neuroendocrine Carcinoma: A Nordic Multicenter Comparative Study
Surgical Treatment as a Principle for Patients with High-Grade Pancreatic Neuroendocrine Carcinoma: A Nordic Multicenter Comparative Study
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DOI：
10.1245/s10434-015-5013-2
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发表时间：
2016-05-01
影响因子：
3.7
通讯作者：
Sorbye, Halfdan
中科院分区：
文献类型：
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作者：
Haugvik, Sven-Petter;Janson, Eva Tiensuu;Sorbye, Halfdan
本研究旨在评估北欧大型多中心队列研究中手术对高级别胰腺神经内分泌癌（hgPNEC）患者的作用。先前评估手术对hgPNEC患者作用的研究有限，手术的益处也不确定。1998年至2012年间诊断为hgPNEC的患者的数据回顾性登记在10所北欧大学医院。采用Kaplan-Meier曲线比较不同治疗组的总生存率，采用cox -回归分析评价可能影响生存率的因素。该研究登记了119名患者。在复发时首次切除局部非转移性疾病并化疗的患者（n = 14），从转移时开始的中位生存期为23个月，切除原发肿瘤并切除/射频消融同步转移性肝病的患者（n = 12）为29个月，而同步转移性疾病仅接受全身化疗的患者（n = 78）为13个月。原发肿瘤和转移性疾病术后3年生存率为69%。原发肿瘤切除是转移性疾病发生后生存率提高的独立因素。切除了局部非转移性hgPNEC和后来转移性疾病的患者似乎从最初切除原发肿瘤中获益。选择切除原发肿瘤和同步肝转移的患者有很高的3年生存率。选择局部hgPNEC和转移性hgPNEC患者应考虑根治性手术治疗。
This study aimed to evaluate the role of surgery for patients with high-grade pancreatic neuroendocrine carcinoma (hgPNEC) in a large Nordic multicenter cohort study. Prior studies evaluating the role of surgery for patients with hgPNEC are limited, and the benefit of the surgery is uncertain.Data from patients with a diagnosis of hgPNEC determined between 1998 and 2012 were retrospectively registered at 10 Nordic university hospitals. Kaplan-Meier curves were used to compare the overall survival of different treatment groups, and Cox-regression analysis was used to evaluate factors potentially influencing survival.The study registered 119 patients. The median survival period from the time of metastasis was 23 months for patients undergoing initial resection of localized nonmetastatic disease and chemotherapy at the time of recurrence (n = 14), 29 months for patients undergoing resection of the primary tumor and resection/radiofrequency ablation of synchronous metastatic liver disease (n = 12), and 13 months for patients with synchronous metastatic disease given systemic chemotherapy alone (n = 78). The 3-year survival rate after surgery of the primary tumor and metastatic disease was 69 %. Resection of the primary tumor was an independent factor for improved survival after occurrence of metastatic disease.Patients with resected localized nonmetastatic hgPNEC and later metastatic disease seemed to benefit from initial resection of the primary tumor. Patients selected for resection of the primary tumor and synchronous liver metastases had a high 3-year survival rate. Selected patients with both localized hgPNEC and metastatic hgPNEC should be considered for radical surgical treatment.