摘要目的 探讨胰腺神经内分泌肿瘤(pNET)的临床病理特征和预后因素.方法 收集2006年1月至2015年12月第二军医大学长海医院胰腺外科手术治疗的103例pNET患者临床资料,男性44例,女性59例,年龄21 ～77岁,中位年龄48岁.103例患者中,功能型21例,无功能型82例.应用Kaplan-Meier法进行单因素生存分析,应用Cox比例风险模型进行多因素生存分析.结果 超声,CT和MRI对本病的检出率分别为60.2％、84.6％和91.3％,病变位于胰头、胰颈和胰体尾部的患者分别为44、18和41例.病理分级以G1级最常见,嗜铬粒素A抗原、Syn、神经元特异性烯醇化酶和CAM 5.2的阳性率分别为97.1％、97.1％、91.3％和93.2％.统计分析结果表明,肿瘤分级(x2=26.077,P＜0.05)、Ki-67指数(x2=25.427,P＜0.05)、欧洲神经内分泌肿瘤协会(ENETS)分期(x2=5.915,P＜0.05)、AJCC分期(x2=8.411,P＜0.05)、有无淋巴结转移(x2=4.770,P＜0.05)及远处转移(x2=8.411,P＜0.05)与pNET预后相关,其中肿瘤分级是其预后因素(HR=3.085,P＜0.01).结论 pNET可位于胰腺任何部位,实验室及多种影像检查相结合有助于早期诊断,免疫组化对其诊断及鉴别诊断有较重要的价值.肿瘤分级、Ki-67指数、ENETS分期、AJCC分期、有无淋巴结转移及远处转移与pNET预后有密切关系,其中肿瘤分级程度越高,预后越差.

abstractsObjective To discuss the clinical pathology characteristics,strategies of diagnosis and therapy,and related prognosis factors of pancreatic neuroendocrine tumors(pNET).Methods Clinical data of 103 pNET cases in Department of Pancreatic Surgery,Changhai Hospital of Second Military Medical University were collected from January 2006 to December 2015.There were 44 males and 59 females,aged from 21 to 77 years with mean age of 48 years.Of the 103 patients,there were functional type in 21 cases and no functional type in 82 cases.Related factors on diagnosis and treatment were summarized.Moreover,univariate survival analysis was performed by Kaplan-Meier method,and COX proportional hazards model was used for multivariate survival analysis.Results The detection rates of the B-ultrasound,CT,MRI were 60.2％,84.6％ and 91.3％,respectively,and there were 44 cases located in pancreatic head,18 cases in pancreatic neck and 41 cases in pancreatic body and tail.G1 was the most common pathological grade,and the positive rates of Chromogranin A,Syn,neuron-specific enolase and CAM5.2 were 97.1％,97.1％,91.3％ and 93.2％,respectively.The results of statistical analysis showed that tumor grade(x2 =26.077,P＜0.05),Ki-67 index (x2 =25.427,P＜0.05),ENETS stage (x2 =5.915,P＜ 0.05),AJCC stage (x2 =8.411,P＜0.05),lymph node metastasis (x2 =4.770,P＜ 0.05) and distant metastasis (x2 =8.411,P＜ 0.05) were associated with the prognosis of pNET,and the tumor grade was an independent risk factor of the pNET'overall prognositic factors (HR=3.085,P＜0.01).Conclusions The pNET can be located in any part of pancreas,and the combination of laboratory and various imaging examinations can help make early diagnosis.In addition,tumor grade,Ki-67 index,ENETS stage,AJCC stage,lymph node metastasis and distant metastasis were closely related to the prognosis of pNET,and the higher the tumor grade,the worse the prognosis.