The question of how successful we are in predicting pancreatic neuroendocrine tumors (panNET) with poor prognosis has not been fully answered yet. The aim of this study was to investigate the effects of clinicopathological features on prognosis and to determine their validity in prediction of prognosis and whether a better prognostic classification can be made. Fifty-six patients who underwent pancreatic resection for pancreatic neuroendocrine tumor were included. The associations between clinicopathological parameters and prognosis were evaluated statistically. Efficiencies of different thresholds for tumor size, mitotic count, and Ki67 proliferation index for prognosis prediction were compared. Vascular invasion was statistically associated with high tumor grade, advanced pT stage, and mortality rate. The presence of non-functional tumor, lymphatic invasion, and > 10 cm tumor size were significantly related to shorter overall survival. Advanced pT stage (pT3–4), > 5 cm tumor size, and high tumor grade (grades 2–3) were significantly associated with shorter disease-free survival. The mortality rate showed the strongest statistical significance with mitotic count when grouped as 1: < 2, 2: 2–10, and 3: > 10 mitosis/ 2 mm². The 10% threshold value for Ki67 index was more successful in predicting adverse prognosis. Among the morphologic variants, the ductulo-insular variant was the most promising to have positive prognostic value in our series, although no statistical significance was detected. In conclusion, threshold values of 5 cm and 10 cm for tumor size, 10% for Ki67 proliferation index, and 10/2 mm² for mitotic count and vascular and lymphatic invasion assessed separately are potential prognostic candidates for better stratification of panNETs.

我们在预测预后不良的胰腺神经内分泌肿瘤 (panNET) 方面有多成功的问题尚未得到完全解答。本研究的目的是调查临床病理学特征对预后的影响，并确定它们在预测预后中的有效性以及是否可以做出更好的预后分类。纳入因胰腺神经内分泌肿瘤行胰腺切除术的 56 例患者。临床病理学参数与预后之间的关联进行了统计学评估。比较了不同阈值对肿瘤大小、有丝分裂计数和 Ki67 增殖指数预测预后的效率。血管侵犯与高肿瘤分级、晚期 pT 分期和死亡率在统计学上相关。非功能性肿瘤的存在，淋巴浸润和 > 10 cm 的肿瘤大小与较短的总生存期显着相关。晚期 pT 分期 (pT3-4)、> 5 cm 肿瘤大小和高肿瘤等级 (2-3 级) 与较短的无病生存期显着相关。当分组为 1：< 2、2：2-10 和 3：> 10 有丝分裂/2 mm 时，死亡率与有丝分裂计数显示出最强的统计学意义² . Ki67 指数的 10% 阈值更能成功预测不良预后。在形态学变异中，导管-岛叶变异在我们的系列中最有希望具有阳性预后价值，尽管未检测到统计学意义。总之，肿瘤大小阈值为 5 cm 和 10 cm，Ki67 增殖指数阈值为 10%，有丝分裂计数阈值为 10/2 mm ²以及分别评估的血管和淋巴浸润是更好的 panNET 分层的潜在预后候选者。