Updates in classification of gastro-entero-pancreatic neuroendocrine neoplasms better reflect the biological characteristics of these tumours. In the present study, we analysed the characteristics of neuroendocrine tumours that could aid in a more precise stratification of risk groups. In addition, we have highlighted the importance of grade (re)assessment based on investigation of secondary tumour lesions. Two hundred and sixty-four cases of neuroendocrine tumours of gastro-entero-pancreatic origin from three centres were included in the study. Tumour morphology, mitotic count and Ki67 labelling index were evaluated in specimens of primary tumours, lymph node metastases and distant metastases. These variables were correlated with overall survival (OS) and relapse-free survival (RFS). Tumour stage, number of affected lymph nodes, presence of tumour deposits and synchronous/metachronous metastases were tested as possible prognostic features. Mitotic count, Ki-67 labelling index, primary tumour site, tumour stage, presence of tumour deposits and two or more affected lymph nodes were significant predictors of OS and RFS. At the same time, mitotic count and Ki-67 labelling index can be addressed as continuous variables determining prognosis. We observed a very high correlation between the measures of proliferative activity in primary and secondary tumour foci. The presence of isolated tumour deposits was identified as an important determinant of both RFS and OS for pancreatic (hazard ratio [HR] = 7.61, 95% confidence interval [CI] = 3.96-14.6, P < 0.0001 for RFS; HR = 3.28, 95% CI = 1.56-6.87, P = 0.0017 for OS) and ileal/jejunal neuroendocrine tumours (HR = 1.98, 95% CI = 1.25-3.13, P = 0.0036 for RFS and HR 2.59, 95% CI = 1.27-5.26, P = 0.009 for OS). The present study identifies the presence of mesenterial tumour deposits as an important prognostic factor for gastro-entero-pancreatic neuroendocrine tumours, provides evidence that proliferative parameters need to be treated as continuous variables and further supports the importance of grade determination in all available tumour foci.

中文翻译：

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原发性和转移性胃肠胰神经内分泌肿瘤的预后特征：分级、肠系膜肿瘤沉积和新出现的新事物

胃肠胰神经内分泌肿瘤分类的更新更好地反映了这些肿瘤的生物学特征。在本研究中，我们分析了神经内分泌肿瘤的特征，这些特征可以帮助对风险组进行更精确的分层。此外，我们强调了基于继发性肿瘤病变调查的分级（重新）评估的重要性。来自三个中心的 264 例胃肠胰源性神经内分泌肿瘤被纳入研究。在原发性肿瘤、淋巴结转移和远处转移的标本中评估肿瘤形态、有丝分裂计数和 Ki67 标记指数。这些变量与总生存期（OS）和无复发生存期（RFS）相关。肿瘤分期、受累淋巴结数量、肿瘤沉积和同步/异时转移的存在被测试为可能的预后特征。有丝分裂计数、Ki-67 标记指数、原发肿瘤部位、肿瘤分期、肿瘤沉积物的存在和两个或更多受累淋巴结是 OS 和 RFS 的重要预测因子。同时，有丝分裂计数和 Ki-67 标记指数可以作为决定预后的连续变量。我们观察到原发性和继发性肿瘤病灶的增殖活性测量值之间存在非常高的相关性。孤立的肿瘤沉积物的存在被确定为胰腺 RFS 和 OS 的重要决定因素（风险比 [HR] = 7.61，95% 置信区间 [CI] = 3.96-14.6，原发肿瘤部位、肿瘤分期、肿瘤沉积物的存在和两个或更多受累淋巴结是 OS 和 RFS 的重要预测因素。同时，有丝分裂计数和 Ki-67 标记指数可以作为决定预后的连续变量。我们观察到原发性和继发性肿瘤病灶的增殖活性测量值之间存在非常高的相关性。孤立的肿瘤沉积物的存在被确定为胰腺 RFS 和 OS 的重要决定因素（风险比 [HR] = 7.61，95% 置信区间 [CI] = 3.96-14.6，原发肿瘤部位、肿瘤分期、肿瘤沉积物的存在和两个或更多受累淋巴结是 OS 和 RFS 的重要预测因素。同时，有丝分裂计数和 Ki-67 标记指数可以作为决定预后的连续变量。我们观察到原发性和继发性肿瘤病灶的增殖活性测量值之间存在非常高的相关性。孤立的肿瘤沉积物的存在被确定为胰腺 RFS 和 OS 的重要决定因素（风险比 [HR] = 7.61，95% 置信区间 [CI] = 3.96-14.6，我们观察到原发性和继发性肿瘤病灶的增殖活性测量值之间存在非常高的相关性。孤立的肿瘤沉积物的存在被确定为胰腺 RFS 和 OS 的重要决定因素（风险比 [HR] = 7.61，95% 置信区间 [CI] = 3.96-14.6，我们观察到原发性和继发性肿瘤病灶的增殖活性测量值之间存在非常高的相关性。孤立的肿瘤沉积物的存在被确定为胰腺 RFS 和 OS 的重要决定因素（风险比 [HR] = 7.61，95% 置信区间 [CI] = 3.96-14.6，对于 RFS， P  < 0.0001；HR = 3.28, 95% CI = 1.56-6.87, P  = 0.0017 for OS）和回肠/空肠神经内分泌肿瘤（HR = 1.98, 95% CI = 1.25-3.13, P  = 0.0036 for RFS 和 HR 2.59, 95% CI = 1.27-5.26，对于 OS， P  = 0.009）。本研究确定肠系膜肿瘤沉积物的存在是胃肠胰神经内分泌肿瘤的重要预后因素，提供了增殖参数需要被视为连续变量的证据，并进一步支持了在所有可用肿瘤病灶中确定分级的重要性。