T1期结肠神经内分泌肿瘤患者转移及接受不同治疗策略后生存分析OACSTPCD
Analysis of metastasis and survival after different treatment in patients with T1 stage colonic neuroendocrine tumors
目的 探讨T1 期结肠神经内分泌肿瘤(colonic neuroendocrine tumor,C-NET)转移率及相关危险因素,比较未转移(T1N0M0 期)C-NET患者接受局部切除治疗(local excision,LE)或根治性手术治疗(radical surgery,RS)后的长期生存情况.方法 分析SEER数据库内 2004 年 1 月 1 日至 2015 年 12 月 31 日经病理学诊断为T1 期C-NET患者的相关信息.采用Cox回归分析评估C-NET患者发生转移的影响因素.将未发生转移的C-NET患者分为LE组和RS组,并采用倾向得分匹配(propensity score matching,PSM),根据患者性别、年龄、肿瘤最大径、浸润深度进行 1∶1 匹配,卡钳值设定为 0.02.使用Kaplan-Meier生存曲线来分析患者 5 年癌症特异性生存(cancer-specific survival,CSS)和总生存(overall survival,OS).采用Cox回归分析评估转移对生存的影响.结果 共纳入 419 例T1 期C-NET患者,其中 19 例(4.53%)发生远处转移.多因素Cox回归分析显示,肿瘤最大径为 11～20 mm(HR=9.264,95%CI 3.322～25.835,P＜0.001)、肿瘤位于右结肠(HR=0.116,95%CI 0.042～0.321,P＜0.001)和黏膜下浸润(HR=5.842,95%CI 1.858～18.371,P= 0.003)是T1 期C-NET远处转移的独立危险因素.未转移与转移患者的 5 年OS率分别是 94.5%和 47.4%(χ2=79.762,P＜0.001),5 年CSS率分别为 99.5%和 55.7%(χ2=164.604,P＜0.001).PSM前未转移C-NET患者LE及RS后 5 年OS率为 95.8%、90.1%(χ2=2.679,P=0.063),5 年CSS率为 100.0%和 97.2%(χ2=0.579,P=0.038);PSM后患者LE及RS后 5 年OS率 为 96.8%和 92.1%(χ2=3.606,P=0.058),5 年CSS率 为 100.0%和 98.5%(χ2=1.015,P=0.314).PSM后LE组和RS组按肿瘤位置、肿瘤最大径和黏膜下浸润分层患者间5 年OS和CSS差异均无统计学意义.结论 肿瘤最大径 11～20 mm、位于右结肠和黏膜下浸润是T1 期C-NET远处转移的独立危险因素;LE可作为未转移T1 期C-NET的合适治疗方案.
Objective To explore the metastasis rate and related risk factors of T1 stage colonic neuroendocrine tumor(C-NET),and to compare the long-term survival outcomes of patients with non-metastatic(T1N0M0 stage)C-NET after local excision(LE)or radical surgery(RS).Methods Clinical information of 433 patients diagnosed with C-NET in the SEER database from January 1,2004 to December 31,2015 were analyzed.Cox regression was used to analyze the influencing factors of metastasis of C-NET.The patients without metastasis were divided into LE group and RS group,and assigned in a 1∶1 ratio using propensity score matching(PSM)according to gender,age,tumor largest diameter,and infiltration depth,with a caliper value set to 0.02.Kaplan-Meier survival curve was used to analyze 5-year cancer-specific survival(CSS)and overall survival(OS)of patients.Cox regression analysis was used to evaluate the influence of metastasis on survival.Results Among 419 C-NET patients,19(4.52%)had distant metastases.Cox regression analysis showed that 11-20 mm of tumor large diameter(HR=9.264,95%CI 3.322-25.835,P＜0.001),right colon location(HR=0.116,95%CI 0.042-0.321,P＜0.001),and submucosal invasion(HR=5.842,95%CI 1.858-18.371,P=0.003)were independent risk factors for distant metastasis of T1 stage C-NET.The 5-year OS rates of non-metastatic and metastatic patients were 94.5%and 47.4%,respectively(χ2=79.762,P＜0.001),and their 5-year CSS rates were 99.5%and 55.7%,respectively(χ2=164.604,P＜0.001).Before PSM,the 5-year OS rates of non-metastatic C-NET patients after LE and RS were 95.8%and 90.1%(χ2=2.679,P=0.063),and the 5-year CSS rates were 100.0%and 97.2%(χ2=0.579,P=0.038);after PSM,the 5-year OS rates of non-metastatic patients after LE and RS were 96.8%and 92.1%(χ2=3.606,P=0.058),and the 5-year CSS rates were 100.0%and 98.5%(χ2=1.015,P=0.314).After PSM,there was no significant difference in the 5-year OS and CSS of patients with defferent tumor location,tumor large diameter,or submucosal invasion between the LE and RS groups.Conclusions 11-20 mm of tumor diameter,right colon location,and submucosal invasion might be independent risk factors for distant metastasis of T1 stage C-NET,and LE could be an appropriate treatment option for non-metastatic C-NET.
白斌;李恒;汪军;肖华;蔡慧
上海中医药大学附属市中医医院肝胆外科,上海 200071上海市宝山区中西医结合医院胃肠外科,上海 201900上海中医药大学附属第七人民医院呼吸内科,上海 200137海军军医大学第一附属医院普通外科,上海 200433
临床医学
神经内分泌肿瘤结肠治疗策略转移SEER数据库
neuroendocrine tumorcolontreatment strategiemetastasisSEER database
《中国临床医学》 2024 (002)
192-199 / 8
上海市宝山区科学技术委员会科技创新专项资金(2023-E-19),上海市浦东新区卫生健康委员会面上项目(PW2021A-28),上海中医药大学附属第七人民医院"启明星"人才培养计划项目(QMX2021-01).Supported by Science and Technology Innovation Special Fund Project of Shanghai Baoshan District Science and Technology Committee(2023-E-19),General Project of Shanghai Pudong New Area Health Commission(PW2021A-28),and Talents Training Program of Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine(QMX2021-01).
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