Background

Non-functional neuroendocrine tumors of the pancreas (NF-pNETs) are uncommon. Consensus guidelines have conflicting recommendations. We performed a nationwide analysis of patterns in management and outcomes based on facility type and tumor size.

Methods

The National Cancer Database (2004–2016) was queried for patients with localized NF-pNETs (<1 cm, 1–2 cm, >2 cm) stratified by facility type. Management decisions, operative outcomes, and survival were compared.

Results

A total of 7170 patients were included in the analysis (<1 cm = 916; 1–2 cm = 2180; >2 cm = 4074). Most patients were treated at academic facilities (62.8%). Over 67% of patients with tumors <1 cm underwent resection, independent of facility type (p = 0.443). There was no association between facility type and operative vs non-operative management of patients with NF-pNETs 1–2 cm in size. Patients treated at academic facilities were more likely to undergo resection for tumors >2 cm compared to other facility types. Resection was associated with improved survival among patients with tumors 1–2 cm (HR = 0.43,p < 0.001) and >2 cm (HR = 0.32,p < 0.001), but not <1 cm (HR = 0.64,p = 0.054), as compared to non-operative management.

Conclusion

There is heterogeneity in management of NF-pNETs across facility types. Treatment at academic facilities appears to be associated with higher resection rates for tumors >2 cm. There appears to be an independent association between operative management and improved survival for tumors ≥1 cm in size.

中文翻译：

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局部非功能性胰腺神经内分泌肿瘤患者管理模式和结果的设施类型和规模分层分析

背景

胰腺的非功能性神经内分泌肿瘤 (NF-pNETs) 并不常见。共识指南有相互矛盾的建议。我们根据设施类型和肿瘤大小对管理模式和结果进行了全国性分析。

方法

国家癌症数据库（2004-2016 年）查询了按设施类型分层的局部 NF-pNET（<1 cm、1-2 cm、>2 cm）患者。比较管理决策、手术结果和生存率。

结果

共有 7170 名患者被纳入分析（<1 cm = 916；1-2 cm = 2180；>2 cm = 4074）。大多数患者在学术机构接受治疗（62.8%）。超过 67% 的肿瘤 <1 cm 的患者接受了切除，与设施类型无关 (p = 0.443)。对于大小为 1-2 厘米的 NF-pNET 患者，设施类型与手术与非手术管理之间没有关联。与其他机构类型相比，在学术机构接受治疗的患者更有可能接受肿瘤 > 2 cm 的切除术。切除与肿瘤 1-2 cm (HR = 0.43,p < 0.001) 和 >2 cm (HR = 0.32,p < 0.001) 的患者的生存率提高有关，但与 <1 cm (HR = 0.64,p = 0.054) 无关)，与非手术管理相比。

结论

不同设施类型的 NF-pNET 管理存在异质性。学术机构的治疗似乎与 > 2 cm 的肿瘤切除率较高有关。对于≥1 cm 的肿瘤，手术管理与提高生存率之间似乎存在独立关联。