| Objective:Through the sorting and statistics of clinical data of patients with pancreatic neuroendocrine tumors(p NETs)undergoing surgery in SEER database,the image of lymph node dissection during p NETs operation on the prognosis of patients was compared.At the same time,we will further explore the influencing factors of lymph node metastasis of p NETs,establish risk score,and provide clinical experience for the treatment of p NETs。Methods:This study retrospectively analyzed the clinical cases and follow-up data of 2079 p NETs patients with complete lymph node surgery information included in SEER database from 2012 to 2019.The baseline information includes the patient’s age,sex,race,tumor size,tumor location,surgical type,tumor differentiation,lymph node dissection during operation,whether lymph nodes are positive,and the patient’s prognosis.First,the patients were divided into lymph node dissection group and uncleaned group.The patients were matched by the tendentity-matching method,and the data were processed and analyzed by SPSS software to compare the prognosis of the two groups.Secondly,according to the results of lymph node examination,the lymph node dissection group was divided into positive group and negative group.The data were analyzed and compared by SPSS software to identify the risk factors affecting lymph node metastasis.Results:2079 patients who met the requirements were divided into 1733 patients in lymph node dissection group and 346 patients in non-dissection group.283 pairs of patients were obtained through propensity matching.The baseline information of lymph node dissection group and non-dissection group: age,sex,race,tumor size,primary site,histopathological grade,etc.had no significant difference(p>0.05),which was comparable.After propensity matching,the 3-year cumulative survival rates of lymph node dissection group and non-dissection group were 94.0% and 87% respectively.Kaplan-Meier analysis showed that the survival period of lymph node dissection group was longer than that of non-dissection group(p=0.0027).The lymph node dissection group was divided into 490 positive group and 1243 negative group.By logistic regression analysis,the primary site of the tumor was located at the head of the pancreas(OR,2.248;95% CI,1.767-2.806;p<0.001),the tumor size was 2-4cm(OR,5.352;95% CI,3.806-7.525;p<0.001),and the size was>4cm(OR,9.559;95% CI,6.694-13.650;p<0.001),and the tumor grade was IIIIV(OR,3.088;95% CI,1.489-5.155;p<0.001),which were independent risk factors for lymph node dissection.According to the OR value,a simple risk score was established to score patients with lymph node dissection,and they were divided into three groups: high risk group(11-15 points),medium risk group(7-10 points),and low risk group(3-6points).The risk of lymphatic metastasis in the high-risk and medium-risk groups was more than 9 and 5 times higher than that in the low-risk group(p<0.001).Conclusion:1.Under the condition that the basic condition of the patient is roughly matched,routine lymph node dissection during tumor resection can help the patient obtain a good prognosis.2.For patients with malignant potential of lymph node metastasis,it is recommended to increase lymph node dissection during tumor resection.The risk prediction model of lymph node metastasis based on tumor size,location and histopathological grading can predict lymph node metastasis before surgery,which has guiding significance for clinical practice. |
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