| Background:Surgical resection is the only curative way for patients with localized well-differentiated pancreatic neuroendocrine tumors(pNETs),but there is a risk of recurrence after surgery.Research on postoperative prognosis analysis of pNENs has become a hot issue in recent years.There is no authoritative guideline recommending adjuvant therapy after surgery.We conducted this study to explore the effect of traditional Chinese medicine(TCM)on preventing recurrence of pNETs patients after surgery.Methods:We analyzed patients retrospectively who had undergone radical resection of localized pNETs at the China-Japan Friendship Hospital from January 2012 to June 2019.We collected basic information,clinical symptoms,surgical and pathological data and imaging data.Patients are divided into TCM group and control group according to whether they receive regular treatment of TCM.We compared the difference of disease-free survival(DFS)between the two groups.At the same time,Univariate and multivariate analysis are used to analyze the risk factors of recurrence after pNETs surgery.Results:A total of 85 patients were enrolled in this study,including 38 male and 47 female.The median age at diagnosis was 49 years(22-81 years).The median follow-up time was 36 months(3-99 months).29 patients received TCM after operation,49 patients did not receive any postoperative adjuvant treatment,and 7 patients received other treatment after operation.Among the enrolled patients,68 were non-functional pNETs and 17 were functional pNETs,including 14 patients with insulinoma,1 with vasoactive intestinal polypeptide,1 with glucagonoma,and 1 with gastrinoma.36 cases found in the head of the pancreas,29 in the body tail,4 in the body,and 16 in the tail.28 patients underwent pancreaticoduodenectomy,34 underwent pancreatectomy combined with or without splenectomy and 23 underwent local tumor resection.The median tumor size was 3.3 cm(0.3-13 cm).18 patients had pathological grade G1,58 G2,and 9 G3.TNM staging:T1:21 cases,T2:25 cases,T3:29 cases,T4:8 cases.N0:63 cases,N1:22 cases.Stage ?:21 cases,Stage ?:37 cases,Stage ?:26 cases.There were 16 patients with nerve invasion,16 with vascular tumor thrombus and 13 patients with positive margins.A total of 25 patients had postoperative recurrence,the recurrence rate was 29.4%.The average DFS was 78.7 months(95%CI 67.2,90.2 months),Among them,there were 29 cases in the TCM group,3 cases relapsed,and the 2-year,3-year and 5-year recurrence rate was 8.2%,13.1%and 13.1%respectively.The average DFS is 101.8 months(95%CI 88.8,114.8 months).A total of 49 cases in the control group,18 cases relapsed,the recurrence rate at 2 years,3 years and 5 and above years was 14.4%,30.7%and 38.7%respectively.The average DFS was 66.9 months(95%CI 55.7,78.0 months).There were statistical differences in DFS between the TCM group and the control group(p=0.04).Univariate analysis shows tumor size,Ki-67 index(whether greater than 5%),grading,clinical stage,lymph node metastasis,and whether receiving adjuvant treatment with TCM are related factors affecting the recurrence of pNETs patients after surgery.Multivariate analysis shows the largest tumor diameter>4cm and positive lymph node are independent factors for recurrence of the postoperative pNETs patients,TCM is a protective factor.Conclusion:TCM as an adjuvant therapy plays an important role in preventing postoperative recurrence for pNETs patients.Further prospective research is needed to provide reference for clinical practice. |
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