关键词: 胰腺神经内分泌肿瘤, 肝转移, 手术治疗, 预后

Abstract: Background　Pancreatic neuroendocrine tumors（PNETs） are relatively rare，but local lymph nodes，liver，lung and bone metastases can occur during disease progression，and among them liver metastasis is the most common.About 50% of patients are prone to liver metastasis.Treatment method affects the survival of such patients.Moreover，it can also influence the patient's quality of life to a certain degree.Objective　To explore the effect of surgical treatment on the prognosis of patients with pancreatic neuroendocrine tumor with liver metastasis，providing a reference for clinical treatment selection for this disease.Methods　Data about PNETs between 2004 and 2013 were obtained from the SEER database.A total of 476 cases with liver metastasis were enrolled，of whom those receiving surgical treatment for removing the primary tumor，and those receiving non-surgical treatment were assigned to surgical group，and non-surgical group，respectively.Baseline and clinical data were analyzed.The endpoint of the study was overall survival.Results　Of the participants，125（26.3%） received surgical treatment，and other 351（73.7%） did not.The average survival time of the surgical group was longer than that of non-surgical group（χ2=57.649，P=0.001）．Subgroup analysis stratified by T-stage showed that，longer average survival time was found in T1，T2，T3 patients with surgical treatment instead of those without non-surgical treatment，respectively（χ2=5.543，P=0.019；χ2=11.494，P=0.001；χ2=34.240，P<0.001）．Subgroup analysis by lymph node metastasis found that，surgical treatment was associated with longer average survival time either in those with lymph node metastasis（χ2=29.392，P<0.001） or those without（χ2=30.722，P<0.001）．Subgroup analysis by grade of histological differentiation demonstrated that，surgical treatment was associated with longer average survival time in those with gradeⅠ-Ⅱ（χ2=18.513，P<0.001） and also in those with grade Ⅲ-Ⅳ（χ2=11.219，P<0.001）．Multivariate Cox proportional hazards regression analysis revealed that older than 60 years〔HR=1.973，95%CI（1.476，2.637）〕，histological differentiation grade Ⅲ or Ⅳ〔HR=3.864，95%CI（2.279，6.551）；HR=2.801，95%CI（1.278，6.141）〕，and non-surgical treatment〔HR=4.845，95%CI（2.853，8.226）〕were independent risk factors for prognosis（P<0.05）．Conclusion　Surgical resection of the primary tumor improves survival.Lymph node metastasis and T-stage were not associated with the survival，but age and tumor histological differentiation had a significant effect on the survival.For patients younger than 60 years，surgical resection of the primary tumor should be considered a treatment strategy.

Key words: Pancreatic neuroendocrine tumor, Liver metastasis, Surgery treatment, Prognosis