Clinical Study On Prevention Of Postoperative Recurrence Of Highly Differentiated Pancreatic Neuroendocrine Neoplasms By Traditional Chinese Medicine

Objective To retrospectively analyze clinicopathological data of patients with postoperative well-differentiated pancreatic neuroendocrine neoplasms(pNENs),and to explore related risk factors of postoperative recurrence of pNENs and effects of traditional Chinese medicine on preventing postoperative recurrence of well-differentiated pNENs.Methods Clinical and pathological data of 47 patients from China-Japan Friendship Hospital with well-differentiated pNENs were analyzed retrospectively.Risk factors of postoperative recurrence of well-differentiated pNENs were analyzed retrospectively.Based on the difference of whether a patient received postoperative adjuvant therapy of Chinese medicine,objects were divided into the Chinese medicine group and the control group.The recurrence rate and disease-free survival(DFS)were compared,and univariate and multivariate analysis of risk factors for postoperative recurrence of pNETs were also conducted.Results For the 47 patients,38 of them had(80.9%)non-functional pNETs and 9(19.1%)were functional pNETs.There were 16 cases(34,0%)with neoplasms in the pancreatic head,15(31.9%)in the pancreatic body and tail,9(19.1%)in pancreatic tail,and 3(6.4%)in pancreatic body.The tumor size ranged from 0.3 cm to 13 cm(4.02 ±2.51).There were 13 cases(27.7%)in G1 grade and 32 cases(68.1%)in G2 grade.In the clinical stage,T1:9 cases(19.1%),T2:20 cases(42.6%),T3:13(27.7%).NO:28 cases(59.6%),N1:16 cases(34%).IA stage 19 cases(19.1%),IB stage 13(27.7%),?A stage 6(12.8%),?B stage 14(29.8%).A total of 22 patients(46.8%)received postoperative adjuvant therapy of Chinese medicine,and 20 patients(42.6%)did not had any postoperative adjuvant therapy,while 5 of them(10.6%)received other treatments.The postoperative reoccurrence were detected on 17 patients.There are 22 objectives in the Chinese medicine group and 5 of them experienced reoccurrence,with 1 year recurrence rate at 5.9%,2-year recurrence rate at 25.1%,3-year recurrence rate at 25.1%,median DFS being 72 mouths(95CI 6.3,137.7 months).There are 20 objectives in the control group and 8 patients suffered from reoccurrence.Thel year recurrence rate for this group was 20%,2-year recurrence rate 52.6%,3-year recurrence rate 68.4%,and the median DFS stood at 23 months(95CI 11.1,34.9 months).Univariate analysis showed that Ki67 index,clinical stage,adjuvant therapy of traditional Chinese medicine,lymph node metastasis,whether the tumor spread beyond the pancreas and tumors margin nature are related to the recurrence of patients with pNETs(P<0.05).The results of multivariate analysis shows that positive lymph nodes and Ki67 positive index being greater than 10%are independent risk factors for postoperative recurrence of pNETs(p<0.05).Postoperative adjuvant therapy with Chinese medicine is a protective factor in the prevention of postoperative recurrence of pNETs.Conclusion The lymph node metastasis and Ki-67 positive index?10%are independent risk factors for postoperative recurrence of pNETs.Postoperative adjuvant therapy of traditional Chinese medicine is a protective factor for postoperative recurrence of pNETs.Chinese medicine is statistically significant in terms of reducing the recurrence rate of pNENs and prolonging DFS.