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胰腺神经内分泌肿瘤诊治分析

The diagnosis and treatment of pancreatic neuroendocrine neoplasms

摘要:

目的 探讨影响胰腺神经内分泌肿瘤患者预后的因素.方法 回顾性分析1995年3月至2012年12月61例胰腺神经内分泌肿瘤患者临床资料.其中男性23例,女性38例;年龄22~68岁,中位年龄52岁.无功能性肿瘤41例,功能性肿瘤20例.59例接受手术治疗,其中13例行腹腔镜手术;2例行CT引导下胰腺肿块活检术.采用Kaplan-Meier法对患者生存情况进行分析.结果 61例患者中,53例(86.9%)行根治性手术.肿瘤分级:G1、G2、G3级分别为41例(67.2%)、9例(14.8%)、11例(18.0%). TNM分期:Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为47例(77.0%)、7例(11.5%)、2例(3.3%)、5例(8.2%).肝转移5例,神经侵犯5例.随访3 ~ 209个月,中位随访时间40个月.1、3、5年生存率分别为92.0%、89.7%、86.3%.单因素生存分析示:肿瘤分级(x2=18.503)、TNM分期(x2=23.401)、肝转移(x2=18.606)、神经侵犯(x2=10.091)、手术性质(x2=25.514)与预后相关(P =0.000).结论 胰腺神经内分泌肿瘤患者手术切除可获得长期生存.新的WHO分级、TNM分期、手术性质可以比较有效地预测肿瘤的预后.肝转移、神经侵犯提示预后不佳.

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abstracts:

Objective To analyze the prognostic factors of pancreatic neuroendocrine neoplasms (PNEN).Methods Clinical data of 61 patients with PNEN from March 1992 to December 2012 was retrospectively analyzed.There were 23 male and 38 female patients,with a median age of 52 years (ranged from 22 to 68 years).Forty-one patients were non-functional tumors,and 20 patients were functional tumors.Fifty-nine patients received operation,13 (22.0%) patients underwent laparoscopic operation,2 patients underwent puncture biopsy under CT guidance.Survival was analyzed with the Kaplan-Meier method.Results Among these patients,53 (86.9%) patients underwent curative resection.The cases of grade G1,G2,G3 were 41 (67.2%),9 (14.8%),11 (18.0%),respectively.The cases of stage Ⅰ,Ⅱ,Ⅲ,Ⅳ were 47 (77.0%),7 (11.5%),2 (3.3%),5 (8.2%),respectively.Liver metastasis,neural invasion were found in 5 cases (8.2%),5 cases (8.2%),respectively.The median follow-up period was 40 months (ranged from 3 to 209 months).The overall 1-,3-,5-year survival rates were 92.0%,89.7%,86.3%,respectively.Univariate analysis showed WHO classification (x2 =18.503),TNM staging system (x2 =23.401),liver metastasis (x2 =18.606),neural invasion (x2 =10.091),resection status (x2 =25.514) were prognostic factors of PNEN (all P =0.000).Conclusions Surgical resection in PNEN results in long-term survival.WHO classification,TNM staging,resection status are effective in predicting the prognosis of PNEN.Liver metastasis,neural invasion predicted poor prognosis.

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作者: 张人超 [1] 牟一平 [1] 徐晓武 [1] 严加费 [1] 陈其龙 [1]
第一作者: 张人超
期刊: 《中华外科杂志》2013年51卷9期 784-787页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2013.09.004
发布时间: 2013-11-11
基金项目:
浙江省科技厅重大科技专项重点社会发展资助项目
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