单中心 26 年非功能性胰腺神经内分泌肿瘤经验：对现行分期系统的验证和新的预后列线图。
A single institution's 26-year experience with nonfunctional pancreatic neuroendocrine tumors: a validation of current staging systems and a new prognostic nomogram.
机构信息
Departments of *Surgery †Pathology ‡Oncology, The Sol Goldman Pancreatic Cancer Research Center, the Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD §Vanderbilt University Medical Center, Department of Pathology, Microbiology and Immunology, Nashville, TN ¶The Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD; and ∥The University of Colorado, Department of Surgery, Aurora, CO.
出版信息
Ann Surg. 2014 Feb;259(2):204-12. doi: 10.1097/SLA.0b013e31828f3174.
OBJECTIVE
To validate the 2010 American Joint Committee on Cancer (AJCC) and 2006 European Neuroendocrine Tumor Society (ENETS) tumor staging systems for pancreatic neuroendocrine tumors (PanNETs) using the largest, single-institution series of surgically resected patients in the literature.
BACKGROUND
The natural history and prognosis of PanNETs have been poorly defined because of the rarity and heterogeneity of these neoplasms. Currently, there are 2 main staging systems for PanNETs, which can complicate comparisons of reports in the literature and thereby hinder progress against this disease.
METHODS
Univariate and multivariate analyses were conducted on the prognostic factors of survival using 326 sporadic, nonfunctional, surgically resected PanNET patients who were cared for at our institution between 1984 and 2011. Current and proposed models were tested for survival prognostication validity as measured by discrimination (Harrel's c-index, HCI) and calibration.
RESULTS
Five-year overall-survival rates for AJCC stages I, II, and IV are 93% (88%-99%), 74% (65%-83%), and 56% (42%-73%), respectively, whereas ENETS stages I, II, III, and IV are 97% (92%-100%), 87% (80%-95%), 73% (63%-84%), and 56% (42%-73%), respectively. Each model has an HCI of 0.68, and they are no different in their ability to predict survival. We developed a simple prognostic tool just using grade, as measured by continuous Ki-67 labeling, sex, and binary age that has an HCI of 0.74.
CONCLUSIONS
Both the AJCC and ENETS staging systems are valid and indistinguishable in their survival prognostication. A new, simpler prognostic tool can be used to predict survival and decrease interinstitutional mistakes and uncertainties regarding these neoplasms.
目的
使用文献中最大的单一机构系列手术切除患者，验证 2010 年美国联合癌症委员会（AJCC）和 2006 年欧洲神经内分泌肿瘤学会（ENETS）的胰腺神经内分泌肿瘤（PanNETs）肿瘤分期系统。
背景
由于这些肿瘤的罕见性和异质性，PanNETs 的自然史和预后一直定义不明确。目前，有两种主要的 PanNETs 分期系统，这可能会使文献中的报告比较复杂化，从而阻碍对这种疾病的进展。
方法
对 1984 年至 2011 年在我们机构接受治疗的 326 例散发性、非功能性、手术切除的 PanNET 患者的生存预后因素进行单变量和多变量分析。使用判别（Harrell 的 c 指数，HCI）和校准来测试当前和提出的模型的生存预后预测有效性。
结果
AJCC 分期 I、II 和 IV 的 5 年总生存率分别为 93%（88%-99%）、74%（65%-83%）和 56%（42%-73%），而 ENETS 分期 I、II、III 和 IV 的 5 年总生存率分别为 97%（92%-100%）、87%（80%-95%）、73%（63%-84%）和 56%（42%-73%）。每个模型的 HCI 为 0.68，它们在预测生存能力方面没有差异。我们开发了一种简单的预后工具，仅使用分级（由连续 Ki-67 标记、性别和二进制年龄测量），HCI 为 0.74。
结论
AJCC 和 ENETS 分期系统在生存预测方面都是有效且不可区分的。一种新的、更简单的预后工具可用于预测生存，并减少这些肿瘤的机构间错误和不确定性。
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