Analysis Of Clinical Data And Prognosis Of Patients With Surgically Resected Pancreatic Neuroendocrine Neoplasms

Background:Pancreatic neuroendocrine neoplasms are relatively rare and highly heterogeneous.Most of them grow slowly and have low degree of malignancy,while they are easily metastasized that liver metastases is the most common.Based on wheather tumor can secrete excessive hormones,PNENs are divided into two types,functional and non-functional.At present,research data for the disease is relatively scarce.With the gradually increase in the incidence of PNENs,it is necessary to provide more research evidences to support that diagnosis and treatment of this disease.Objectives:To explore the clinical characteristic,treatment of PNENs and the prognostic factors of patients with nonmetastatic,surgically resected PNENs,clarify the application value of tumor enucleation to PNENs.Methods:Retrospectively analyzing 60 patients with PNENs who had positive diagnosis of postoperative histology between Jan 2009 and July 2020 in Nanfang Hospital of Southern Medical University,and 1508 patients who were undergoing surgical resection collected from SEER database.between 2004 and 2014.We explored the process of clinical diagnosis and treatment for PNENs,using Kaplan-Meier method,Log-rank and Cox multivariate regression model to estimate the prognostic factors of patients with nonmetastatic,surgically resected PNENs.P<0.05 was regarded as statistically significant.Results:Among 60 cases of Nanfang Hospital,it included 21 males and 39 females.The average age was 46.2±13.4.Functional PNENs mainly consist of insulinomas,these patients were admitted to the hospital due to clinical symptoms caused by hypoglycemia,namely the whipple triad.The chief complaint of non-functional PNENs were abdominal pain,or tumors found in physical examinations.The accuracy of abdominal ultrasound was 75.6%,CT was 89.7%,MRI was 93.8%and the endoscopic ultrasound was 100%.The positive rates of CgA,Syn,CK,CD56,and NSE in postoperative pathological immunohistochemistry were 90.0%,93.1%,84.6%,92.0%,66.7%.The positive rates of CA199,AFP,and CEA were 10.0%,6.9%,and 10.3%respectively.Tumor enucleation took shorter operation time than standard pancreatic resection(P<0.001),and the amount of intraoperative blood loss was less(P<0.001).There is no statistically significance on the comparison of postoperative pancreatic leakage,IGT and other complications for different operations.At second part,Log-rank univariate analysis showed that gender,diagnosis year,tumor location,pathological grade,surgical type,tumor size,AJCC 8th stage,lymph node metastasis,and age affected the OS/DSS of PNENs patients after surgery;Cox multivariate regression model showed gender,Tumor location,pathological grade,tumor size,AJCC 8th stage,and age were independent prognostic factors for the OS/DSS of patients.Univariate analysis showed,that patients with grade 1、tumor diameters≤4cm had better OS/DSS after enucleation.Conclusion:1.The incidence of PNENs is higher among middle-aged people.Insulinoma is more common in functional PNENs.Non-functional PNENs have no specific clinical manifestations.CT,MRI,and ultrasound endoscopy are reliable imaging diagnostic methods for PNENs.Serum tumor markers CA199,AFP,CEA have limited value in the diagnosis of PNENs.Pathological immunohistochemical markers CgA,Syn,and CD56 had the higher positive rate.2.Gender,tumor location,tumor grade and stage,diameter of tumor and patient age are independent factors for the long-term prognosis of postoperative patients without distant metastasis;women,pancreatic body and tail tumors are protective factors,pathological grades 3,AJCC 8th stage Ⅲ,larger tumor and>60 years old have worse OS/DSS in patients.3.Enucleation might be a safe and effective procedure for PNENs with pathological grade 1,tumor of diameter ≤4cm,and a safe distance(>3mm)from the pancreatic duct.