Surgical Diagnosis And Treatment Of Pancreatic Neuroendocrine Tumors:an Analysis In 30 Patients

Objective:To analyze the diagnosis,surgical treatment and prognostic factors of pancreatic neuroendocrine tumors(pNETs).Methods:The clinical data of 30 patients admitted in our hospital during Mar.2006 to Jul.2015 were retrospectively analyzed.Survival analysis was carried out by Kaplan-Meier method.Results:Among the 30 patients,11 were males and 19 were females,with the average age of(47±13)years old.Twelve patients got functional pNETs and the rest got non-functional pNETs.Patients with functional pNETs were mainly manifested with the increase of the blood hormone level and corresponding hormone syndrome,such as Whipple triad syndrome;patients with non-functional pNETs displayed nonspecific space-occupying symptoms in pancreas,such as abdominal pain,abdominal distension,and jaundice.The detection rates of type-B ultrasonic,CT,MRI and EUS on pancreatic tumors were 66.67%(10/15),95.65%(22/23),100%(9/9),and 100%(2/2),respectively.All the 30 patients received surgical treatments,28 took radical surgeries,and 2 underwent palliative surgeries.There were hepatic metastases in 4 cases,lymph node metastases in 5 cases,vascular invasion in 2 cases.The rates of invasion or metastasis and the tumor volume of nonfunctional pNETs were higher than those of functional pNETs(P<0.05).Immunohistochemistry showed that the positive rates of CgA,SYN and NSE were 90%,86.67%and 36.67%respectively.Twenty-eight patients got followed-up successfully after surgery,with the average follow-up duration of(59.57±33.43)months,showing 83.4%in five-year survival rates.According to TNM tumor staging criteria[American Joint Committee on Cancer(AJCC),version 7],there were 17,6,2 and 3 patients with stage Ⅰ,Ⅱ,Ⅲand IV,respectively,and their corresponding five-year survival rates were 100%,83.3%,50.0%and 33.3%,respectively.According to the tumor grading criteria(WHO,2010 version),patients with G1,G2 and G3 were 8,5 and 2,respectively in the patients admitted after 2010,and the corresponding five-year survival rates were 100%,75.0%and 50.0%,respectively.Single factor analysis suggested that the tumor grading,tumor staging,hepatic metastases,lymph node metastases were associated with the prognosis of pNETs patients(P<0.05).Conclusions:1.The specific hormones secreted by pNETs and their associated clinical symptoms provide the basis for classification and diagnosis of functional pNETs.CT,MRI are commonly used location diagnostic methods for pNETs,and the detection rate of CT is higher than that of type-B ultrasonic.In the specific tumor markers of pNETs,the positive rates of CgA and SYN were higher than those of NSE.2.Compared with functional pNETs,nonfunctional pNETs showed higher tumor progression in the terms of invasion or metastasis,and tumor volume.3.Surgery offers a cure for pNETs patients,and in most cases a longer lifetime is achieved by appropriate surgical treatment.4.Liver metastasis,lymph node metastasis,tumor grading and tumor staging are the important factors that affect the prognosis and survival of pNETs.WHO(2010 version)tumor grading and TNM(AJCC version 7)tumor staging are preferably available to assess the prognosis and survival state of patients with pNETs.