A Preliminary Study On The Surgical Treatment Of Pancreatic Neuroendocrine Tumors (With Analysis Of 52 Cases)

Neuroendocrine neoplasm(NEN)is a group of highly heterogeneous tumors of neuroendocrine system origin,complex and diverse,with a broad spectrum of clinical features and lack of specificity.The tumors can occur anywhere in the body,with the majority occurring in the digestive system,followed by the lung,and 7% of those in the GI tract occurring in the pancreas.Pancreatic neuroendocrine neoplasm(PNEN)is one of the worst prognosis types in the NEN spectrum in the digestive system due to its aggressive nature,high malignancy and early metastasis.Surgical resection is currently the preferred treatment option for PNEN and is the only method that has a chance of being curative.In recent years,with the improvement of medical science and technology and diagnostic imaging,the incidence of PNEN has been increasing year by year,but because PNEN is still a rare disease,most studies have small samples and lack representativeness.Therefore,there is a need for continuous in-depth research regarding its epidemiology,treatment management and survival prognosis.Objectives:To investigate the characteristics of clinical presentation and analysis of metastasis and prognostic factors affecting pancreatic neuroendocrine tumors.Methods:The clinical data of 52 patients with PNEN diagnosed by histopathological analysis and seen at the First Affiliated Hospital of Nanchang University from January 2010 to November 2020 were retrospectively analyzed.The SPSS26.0software was used to analyze the patients’ gender,age,clinical symptoms,imaging examinations,laboratory examinations,tumor location,tumor size,degree of tumor invasion,pathological features,treatment methods and factors of metastasis and prognosis.Among them,the risk factors affecting tumor metastasis were analyzed by binary logistic regression;the Kaplan-merier method was used for survival analysis and survival curves were plotted,and Cox regression was used for multifactor analysis,setting P < 0.05 as a statistically significant difference.Results:1.Among 52 patients with PNEN,17(32.6%)were male and 35(67.3%)were female,with a male to female ratio of 0.48:1.mean age(54.2±11.3 years).There were33(63.4%)older than 55 years and 19(17.3%)younger than 55 years.2.Of all PNEN cases,18(34.62%)were F-PNEN,33(63.46%)were NF-PNEN,and one additional case was diagnosed as MEN1(1.92%).The clinical presentation of PNEN patients lacked specificity and was similar to the clinical presentation of common gastrointestinal diseases.3.For imaging examination,there were 20 cases of color ultrasound examination,among which 9 cases were detected with tumor occupancy,with a detection rate of45%;52 cases of enhanced CT examination,among which 46 cases were detected with tumor,with a detection rate of 88.4%;30 cases of MRI examination,among which 27 cases were detected with tumor,with a detection rate of 90%;11 cases of EUS examination,among which all 11 cases were detected with tumor,with a detection rate of In addition,5 cases underwent PET-CT examination,and all 5 cases detected tumors,with a detection rate of 100%.4.52 patients with PNEN had a maximum tumor diameter of 15.7 cm and a minimum diameter of 0.7 cm,with a mean value of 3.4±2.7 cm.TNM stage: 21 cases(40.3%)in stage I,15 cases(28.8%)in stage II,10 cases(19.2%)in stage III,and 6cases(11.5%)in stage IV.WHO classification: 30 cases(40.3%)in G1,15 cases(28.8%)in G2,3 cases(5.7%)in G3,and 4 cases(7.5%)in G3(NEC).(NEC)in 4cases(7.6%).Immunohistochemical results suggested that the positive rate of neuron-specific enolase(NSE)was 86.2%;synaptophysin(Syn)was 86.1%;CD56was 79.4%;chromogranin A(Cg A)was 80.5%.6 cases(11.5%)had Ki-67>20% and46 cases(88.4%)had Ki-67≤20%.5.Analysis of risk factors affecting metastasis showed that gender(P=0.032),tumor size(P=0.006),TNM stage(P<0.001),and WHO grade(P<0.001)were the single risk factors affecting metastasis in PNEN.Multivariate analysis showed that WHO grade,TNM stage and tumor size were independent risk factors affecting metastasis.6.The results of survival analysis showed that age(P=0.022),clinical classification(P=0.048),liver metastasis(P=0.025),lymph node metastasis(P=0.028),TNM stage(P<0.001),surgical resection(P=0.008)and WHO classification(P<0.001)were correlated with prognosis.Indicators with statistically different results from univariate analysis were analyzed by multifactorial Cox regression model,and the results showed that:age,TNM stage and surgical resection were independent influencing factors on prognostic survival.Conclusion:1.The incidence of PNEN is increasing year by year,and the clinical features lack specificity;there are more female patients than male patients;age >55 years is the high incidence age group of the disease;there are more NF-PNEN patients than F-PNEN patients.2.The detection rate of EUS and PET-CT in preoperative imaging of PNEN is significantly higher than that of color ultrasound,CT,and MRI;PNEN is more common with moderate to high differentiation(G1/G2 grade);TNM stage III/IV and WHO grade G3 have a poor overall prognosis.3.TNM stage,WHO classification and tumor size are independent risk factors for PNEN metastasis.4.Age,clinical classification,TNM stage,pathological grade,metastasis,and surgical resection were correlated with PNEN prognosis,with TNM stage III/IV,pathological grade G3,and surgical prognosis having more significant effects.5.Age,TNM stage and surgical resection were independent influences on prognostic survival.6.Surgery is currently one of the most important modalities in the treatment of PNEN.