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Clinicopathologic and prognostic significance of multiple hormone expression in pancreatic neuroendocrine tumors.

胰腺神经内分泌肿瘤中多项激素表达的临床病理和预后意义

Kim JY,Kim MS,Kim KS,Song KB,Lee SH,Hwang DW,Kim KP,Kim HJ,Yu E,Kim SC,Jang HJ,Hong SM

Abstract

Pancreatic neuroendocrine tumors (PanNETs) produce variable peptide hormones. The expression status of some hormones has been linked to the biological and clinical behaviors of PanNETs. A total of 226 surgically resected PanNETs were selected. Immunolabeling for peptide hormones was compared with various clinicopathologic factors, including patient survival. Expression of insulin, glucagon-like peptide 1, glucagon, gastrin, somatostatin, and serotonin were observed in 56 (24.8%), 41 (18.1%), 25 (11.1%), 5 (2.2%), 5 (2.2%), and 4 (1.8%) cases, respectively. Expression of 1, 2, and 3 hormones was noted in 70 (31.0%), 28 (12.4%), and 3 (1.3%) cases, respectively; 125 cases (55.3%) were negative for all hormones. PanNETs with insulin and glucagon-like peptide 1 expression were associated with a lower grade, smaller size, lower pT and pN classifications, absence of lymphovascular invasion, and lymph node metastasis and had better survival by univariate analysis, whereas PanNETs with gastrin expression were associated with a higher grade, larger size, higher pT and pN classifications, presence of lymphovascular invasion, and lymph node metastasis and had worse survival. Gastrin expression, increased age, and tumor grade were negative prognostic factors in multivariate analysis. As the number of hormones expressed increased, the survival rate of PanNET patients increased. In summary, PanNET patients showing insulin or glucagon-like peptide 1 expression and increased numbers of expressed hormones had a better survival outcome by univariate analysis, whereas gastrin expression was a negative prognostic indicator in surgically resected PanNET patients.

摘要

胰腺神经内分泌肿瘤(PanNETs)能产生不同的肽类激素,有几种激素的表达状态与PanNETs的生物学行为和临床行为有关。本研究选取226例手术切除PanNETs病例,免疫标记肽类激素并与包括患者生存率在内的多项临床病理因素相比较分别有56例(24.8%)、41例(18.1%)、25例(11.1%)、 5例(2.2%)、5例(2.2%)和4例(1.8%)表达胰岛素、胰高血糖素样肽1、胰高血糖素、胃泌素、生长激素抑制素和血清素,分别有70例(31.0%)、28例(12.4%和3例(1.3%)表达一种、两种和三种激素,125例(55.3%) 显示所有激素均阴性。单变量分析显示,表达胰岛素和胰高血糖素样肽1的PanNETs与分级较低、肿瘤体积较小、肿瘤和淋巴结病理分期较低、缺乏脉管浸润和淋巴结转移以及生存率较高相关,而表达胃泌素的PanNETs与分级较高、肿瘤体积较大、 肿瘤和淋巴结病理分期较高、存在脉管浸润和淋巴结转移以及生存率降低相关。多变量分析显示,表达胃泌素、患者年龄大、肿瘤分级高是不利于预后的因素。PanNET患者生存率随着激素表达种类的增加而增加。总之,单变量分析显示,表达胰岛素或胰高血糖素样肽1以及激素表达种类增加的PanNET患者,生存率提高,而表达胃泌素是手术切除PanNET患者不利于预后的指标。
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