1/2 级 PanNET 大多采用类似的治疗方法，通常不进行任何辅助治疗，因为人们相信它们的总体转移率较低。在肿瘤学文献中，10% 的 Ki67 指数越来越多地被用作将患者分层到不同方案的分界值，尽管没有基于系统病理学的研究支持这种方法。Ki67 指数与 190 个切除的 PanNET 中的临床病理参数相关。单独分析了验证队列 (n = 145)。在初始队列中，最大选择排名统计方法显示 12% 是歧视性截止值（接近 10% 的经验法则）。 G2b 病例的肝脏/远处转移率几乎比 G2a 高出三倍，并且所有侵袭性组织病理学体征（肿瘤大小、神经周围/血管侵犯、浸润性生长模式、淋巴结转移）的频率显着更高。在验证队列中，这些数字同样引人注目。当所有病例一起分析时，与 G1 相比，G2b 类别的肝脏/远处转移率高出 9 倍（6.1 vs. 58.5%；p < 0.001），淋巴结转移率高出 3 倍（20.5 vs. 65.1%；p） < 0.001)。G2b PanNET 的行为与 G3 非常相似，支持将其视为潜在治疗候选者的管理协议。关于局部管理，G2b 病例的转移行为表明它们可能不适合保守方法，例如观察等待或摘除。这种分期应纳入诊断指南，并需要设计临床试验来确定 G2b（10% 至 ≤ 20%）组更合适的治疗方案，该组超过一半的病例显示肝/远处转移，这至少需要更密切的跟进。© 2024。作者。

Grade 1/2 PanNETs are mostly managed similarly, typically without any adjunct treatment with the belief that their overall metastasis rate is low. In oncology literature, Ki67-index of 10% is increasingly being used as the cutoff in stratifying patients to different protocols, although there are no systematic pathology-based studies supporting this approach.Ki67-index was correlated with clinicopathologic parameters in 190 resected PanNETs. A validation cohort (n = 145) was separately analyzed.In initial cohort, maximally selected rank statistics method revealed 12% to be the discriminatory cutoff (close to 10% rule of thumb). G2b cases had liver/distant metastasis rate of almost threefold higher than that of G2a and showed significantly higher frequency of all histopathologic signs of aggressiveness (tumor size, perineural/vascular invasion, infiltrative growth pattern, lymph node metastasis). In validation cohort, these figures were as striking. When all cases were analyzed together, compared with G1, the G2b category had nine times higher liver/distant metastasis rate (6.1 vs. 58.5%; p < 0.001) and three times higher lymph node metastasis rate (20.5 vs. 65.1%; p < 0.001).G2b PanNETs act very similar to G3, supporting management protocols that regard them as potential therapy candidates. Concerning local management, metastatic behavior in G2b cases indicate they may not be as amenable for conservative approaches, such as watchful waiting or enucleation. This substaging should be considered into diagnostic guidelines, and clinical trials need to be devised to determine the more appropriate management protocols for G2b (10% to ≤ 20%) group, which shows liver/distant metastasis in more than half of the cases, which at minimum warrants closer follow-up.© 2024. The Author(s).