胰腺神经内分泌肿瘤合并肝转移的治疗研究进展

Research progress in the treatment of pancreatic neuroendocrine neoplasms with liver metastases

摘要:

胰腺神经内分泌肿瘤（pNEN）是一类罕见且具有高度异质性的胰腺肿瘤，临床表现隐匿，易发生远处转移，其中肝转移最为常见，显著影响患者的预后。尽管近年来对pNEN肝转移的治疗进行了诸多探索，但仍存在诸多争议和空白。随着多学科诊疗模式的发展，pNEN肝转移的治疗策略不断优化，涵盖外科手术、局部治疗（如射频消融、经动脉介入治疗）、全身治疗（如化疗、靶向治疗、免疫治疗、放射性核素治疗、内分泌治疗）等多种手段，且联合治疗已成为重要趋势。对于可手术患者，根治性切除仍是首选，而对于不可手术或耐受性较差的患者，局部治疗与全身治疗的合理联合可改善生存结局。此外，功能性pNEN患者可通过内分泌治疗缓解症状，提高生活质量。多学科协作制定个体化治疗方案，能够显著改善患者预后。本文综述了pNEN肝转移的治疗进展，以期为临床决策提供参考。

Abstract:

Pancreatic neuroendocrine neoplasms (pNENs) are rare and highly heterogeneous pancreatic tumors with insidious clinical manifestations. They have a high propensity for distant metastasis, with liver metastases being the most common, significantly impacting patient prognosis. Despite extensive research on treating pNEN with liver metastases in recent years, many controversies and gaps remain. With the advancement of multidisciplinary treatment approaches, therapeutic strategies for pNEN liver metastases have been continuously refined, encompassing surgical resection, local therapies (such as radiofrequency ablation and transarterial interventions), and systemic treatments (including chemotherapy, targeted therapy, immunotherapy, radionuclide therapy, and endocrine therapy). Combination therapy has become an emerging trend. Radical surgery remains the preferred option for resectable cases, while for inoperable or treatment-intolerant patients, a rational combination of local and systemic therapies can improve survival outcomes. Additionally, endocrine therapy is crucial in symptom relief and quality-of-life improvement for patients with functional pNEN. Multidisciplinary collaboration in formulating individualized treatment plans can significantly enhance patient prognosis. This review summarizes recent advancements in treating pNEN liver metastases, providing a reference for clinical decision-making.