Background The most appropriate nodal staging system for non-functioning pancreatic neuroendocrine tumours (NF-PanNETs) remains unclear. Despite some evidence are available for pancreaticoduodenectomy (PD), the adequate nodal staging is still unknown for distal pancreatectomy (DP). Aim of the present study was to evaluate the prognostic impact of the number of positive lymph nodes after DP for NF-PanNENs and to define the minimal number of lymph nodes to be harvested for an appropriate nodal staging. Methods Data were retrospectively collected from patients who underwent DP with curative intent (R0-R1) for sporadic well-differentiated NF-PanNETs in four Europeans high-volume centers. NF-PanNETs with nodal involvement (N+) were sub-classified into N1 (1 to 3 positive lymph nodes) and N2 (4 or more positive lymph nodes). Univariate and multivariate analyses of disease-free survival (DFS) were performed. Results Out of 271 patients in the study, 62 (23%) had nodal involvement (N+). A higher probability of N+ was associated to the following factors: grading, resection margins status, perineural and microvascular invasion and the number of examined lymph nodes. 3-years DFS rate for N0, N1 and N2 patients was 92%, 72% and 50%, respectively (P< 0.001). At multivariate analysis independent predictors of DFS were grading, T stage, presence of necrosis and nodal status. For patients with ≥ 12 examinedresected lymph nodes, the N status remained a significant predictor of disease recurrence (P< 0.001), while it failed to predict recurrence in patients with <12 lymph nodes examinedresected (P= 0.116). Conclusions A minimal number of 12 nodes should be harvested in case of distal pancreatectomy for NF-PanNET for an appropriate nodal staging. The number of positive lymph-nodes is an independent predictor of DFS survival after DP for NF-PanNET and the N0/N1/N2 nodal classification seems to be more relevant than the current N0/N+ staging.


中文翻译：

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胰腺远端切除术后检查和阳性淋巴结对无功能神经内分泌肿瘤的预后作用。

背景 最适合无功能胰腺神经内分泌肿瘤 (NF-PanNETs) 的淋巴结分期系统仍不清楚。尽管有一些关于胰十二指肠切除术 (PD) 的证据，但对于远端胰腺切除术 (DP) 来说，适当的淋巴结分期仍然未知。本研究的目的是评估 DP 后阳性淋巴结数量对 NF-PanNENs 的预后影响，并确定为适当的淋巴结分期收集的最小淋巴结数量。方法 回顾性收集在四个欧洲高容量中心接受 DP 治疗的患者（R0-R1）的零星分化良好的 NF-PanNETs 的数据。淋巴结受累 (N+) 的 NF-PanNET 被细分为 N1（1 至 3 个阳性淋巴结）和 N2（4 个或更多阳性淋巴结）。进行了无病生存（DFS）的单变量和多变量分析。结果 在研究中的 271 名患者中，62 名（23%）有淋巴结受累（N+）。N+ 的较高概率与以下因素相关：分级、切缘状态、神经周围和微血管侵犯以及检查的淋巴结数量。N0、N1 和 N2 患者的 3 年 DFS 率分别为 92%、72% 和 50%（P<0.001）。在多变量分析中，DFS 的独立预测因子是分级、T 分期、坏死的存在和淋巴结状态。对于检查切除淋巴结≥12 个的患者，N 状态仍然是疾病复发的重要预测因子（P<0.001），而对于检查切除淋巴结<12 个的患者，N 状态不能预测复发（P=0.116）。结论 NF-PanNET 的胰腺远端切除术中应采集最少 12 个淋巴结，以进行适当的淋巴结分期。阳性淋巴结的数量是 NF-PanNET DP 后 DFS 存活的独立预测因子，N0/N1/N2 淋巴结分类似乎比当前的 N0/N+ 分期更相关。