Introduzione: I tumori pancreatici neuroendocrini non funzionanti (NF-PNET) asintomatici ben differenziati sono un’entità sempre più spesso diagnosticata e la loro gestione è controversa vista la loro buona prognosi seppur eterogenea. Scopo: Scopo dello studio è stato quello di valutare la storia naturale dei NF-PNET sporadici asintomatici con diametro < 2 cm valutando il rapporto rischio-beneficio di una gestione conservativa. Metodi: Tra Gennaio 2000 e Giugno 2011, 46 pazienti con una diagnosi di NF-PNET < 2 cm sono stati inseriti in un programma di follow-up di almeno 18 mesi con imaging seriale in due centri di riferimento Risultati: I pazienti sono stati prevalentemente di sesso femminile (65%) con un’età mediana di 60 anni. I tumori erano principalmente localizzati a livello della testa del pancreas (52%) con un diametro mediano di 13 mm (9-15 mm). Dopo un follow-up mediano di 34 mesi (24-52 mesi) e una media di 4 imaging seriali (3-6), non si sono osservate metastasi a distanza o linfonodali. In 6 pazienti (13%) è stato osservato un aumento dimensionale del 20%. La crescita mediana complessiva tumorale è stata di 0.12 mm all’anno e non è stato identificato nessun fattore correlate al paziente o al tumore predittivo di crescita tumorale. Complessivamente, 8 pazienti (17%) sono stati sottoposti a intervento chirurgico dopo un tempo mediano di 41 mesi (27-58 mesi). Tutte le lesioni sottoposte a resezione sono state classificate come stadio I (n=7) o 2 (n=1) di grado 1, con assenza di metastasi linfonodali e invasione vascolare. Conclusioni: In pazienti selezionati una gestione conservativa di NF-PNET sporadici asintomatici < 2 cm è sicura. Necessitiamo di studi prospettici per validare questa politica di “wait and see”.
Introduction: Asymptomatic sporadic non-functioning well-differentiated pancreatic neuroendocrine tumors (NF-PNET) are increasingly diagnosed, and their management is controversial because of their overall good but heterogeneous prognosis. Objective: To assess the natural history of asymptomatic sporadic NF-PNETs smaller than 2 cm in size and the risk-benefit balance of non-operative management. Methods: From January 2000 to June 2011, 46 patients with proven AS-NF-PNET smaller than 2 cm in size were followed-up for at least 18 months with serial imaging in tertiary referral centers. Results: Patients were mainly female (65%), with a median age of 60 years. Tumors were mainly located in the pancreatic head (52%), with a median lesion size of 13 mm (9 –15). After a median follow-up of 34 months (24 –52) and an average of 4 (3– 6) serial imaging sessions, distant or nodal metastases appeared on the imaging in none of the patients. In 6 (13%) patients, a 20% increase in size was observed. Overall median tumor growth was 0.12 mm per year and neither patients nor tumor characteristics were found to be significant predictors of tumor growth. Overall, 8 patients (17%) underwent surgery after a median time from initial evaluation of 41 months (27–58); all resected lesions were ENETS T stage 1 (n=7) or 2 (n=1), grade 1, node negative, with neither vascular nor peripancreatic fat invasion. Conclusions: In selected patients, non-operative management of asymptomatic sporadic NF-PNET smaller than 2 cm in size is safe. Larger and prospective multicentric studies with long-term follow-up are now needed to validate this “wait and see” policy.
OBSERVATIONAL STUDY OF NATURAL HISTORY OF SMALL SPORADIC NONFUNCTIONING PANCREATIC NEUROENDOCRINE TUMORS
PARTELLI, Stefano
2014-01-01
Abstract
Introduction: Asymptomatic sporadic non-functioning well-differentiated pancreatic neuroendocrine tumors (NF-PNET) are increasingly diagnosed, and their management is controversial because of their overall good but heterogeneous prognosis. Objective: To assess the natural history of asymptomatic sporadic NF-PNETs smaller than 2 cm in size and the risk-benefit balance of non-operative management. Methods: From January 2000 to June 2011, 46 patients with proven AS-NF-PNET smaller than 2 cm in size were followed-up for at least 18 months with serial imaging in tertiary referral centers. Results: Patients were mainly female (65%), with a median age of 60 years. Tumors were mainly located in the pancreatic head (52%), with a median lesion size of 13 mm (9 –15). After a median follow-up of 34 months (24 –52) and an average of 4 (3– 6) serial imaging sessions, distant or nodal metastases appeared on the imaging in none of the patients. In 6 (13%) patients, a 20% increase in size was observed. Overall median tumor growth was 0.12 mm per year and neither patients nor tumor characteristics were found to be significant predictors of tumor growth. Overall, 8 patients (17%) underwent surgery after a median time from initial evaluation of 41 months (27–58); all resected lesions were ENETS T stage 1 (n=7) or 2 (n=1), grade 1, node negative, with neither vascular nor peripancreatic fat invasion. Conclusions: In selected patients, non-operative management of asymptomatic sporadic NF-PNET smaller than 2 cm in size is safe. Larger and prospective multicentric studies with long-term follow-up are now needed to validate this “wait and see” policy.File | Dimensione | Formato | |
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