Diagnosis, Natural History, Management and molecular ins

胃泌素瘤和其他恶性胰腺内分泌肿瘤(PET‘s)的自然病史、预后、治疗和分子基础主要基于既往报道和小系列报道。无论患者是否患有MEN1，胃泌素瘤都是最常见的有症状的恶性PET，有足够数量的此类患者被纳入我们的方案，以便进行系统的评估。目前正在进行研究，评估这些肿瘤的自然病史，包括肿瘤的表现和初步诊断，以及决定预后的因素的定义，包括试图确定具有预后意义的肿瘤的分子特征。我们的研究已经确定了25%的胃泌素瘤患者具有侵袭性生长，25%的患者患有多发性内分泌肿瘤1型(MEN1)。对不同预后的患者的识别使我们能够对肿瘤进行分子研究，试图识别可能导致侵袭性生长的基因异常。今年在胃泌素瘤中发现胰岛素样生长因子1(IGF-1)及其受体的表达增加，它们的存在与肿瘤的低治愈率、肿瘤生长和转移的发展有关。在以前的研究中，我们发现了MEN1基因、HER2/neu基因、p16基因和其他生长因子的异常，但没有一个基因异常与IGF-1/IGF-1R变化与肿瘤侵袭性生长密切相关。这些分子预后标记物的可用性可能被证明在临床上有助于识别需要更积极的抗肿瘤治疗的患者。

The natural history, prognosis,management and molecular basis of gastrinomas and other malignant pancreatic endocrine tumors (PET's) in patients without (sporadic disease) or with multiple endocrine neoplasia-type 1 (MEN1) is largely based on antedotal reports and small series. Gastrinomas are the most common symptomatic, malignant PET in patients with or without MEN1 and sufficient numbers of these patients have been entered into our protocols to allow systematic assessment. Studies are now underway, evaluating the natural history of these tumors including the presentation and initial diagnosis and definition of factors determining prognosis including attempting to identify molecular characteristics of the tumor that have prognostic significance. Our studies have identified a cohort of 25% of patients in whom the gastrinomas have aggressive growth and 25% who have multiple endocrine neoplasia type 1 (MEN1). The identification of patients with different prognoses allows us to do moleular studies of the tumor to attempt to identify genetic abnormalities that might contribute to aggressive growth. An increased expression of the insulin-like growth factor 1 (IGF-1) and its receptor was found in gastrinomas this year and their presence corrleated with a low curability, increased tumor growth nd the development of metastases. In previous studies we identified abnormalities in the MEN1 gene, HER2/neu gene, p16 gene and other growth factors but none correlated as strongly as IGF-1/IGF-1R alterations with aggressive tumor growth. The availability of these molecular prognostic markers may prove clinically useful to identify patients who need more aggressvie anti-tumor treatment.