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白斌, 李恒, 汪军, 等. 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[J]. 中国临床医学, 2024, 31(2): 192-199. DOI: 10.12025/j.issn.1008-6358.2024.20231653
引用本文: 白斌, 李恒, 汪军, 等. 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[J]. 中国临床医学, 2024, 31(2): 192-199. DOI: 10.12025/j.issn.1008-6358.2024.20231653
BAI Bin, LI Heng, WANG Jun, et al. Analysis of metastasis and survival after different treatment in patients with T1 stage colonic neuroendocrine tumors[J]. Chinese Journal of Clinical Medicine, 2024, 31(2): 192-199. DOI: 10.12025/j.issn.1008-6358.2024.20231653
Citation: BAI Bin, LI Heng, WANG Jun, et al. Analysis of metastasis and survival after different treatment in patients with T1 stage colonic neuroendocrine tumors[J]. Chinese Journal of Clinical Medicine, 2024, 31(2): 192-199. DOI: 10.12025/j.issn.1008-6358.2024.20231653

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

Analysis of metastasis and survival after different treatment in patients with T1 stage colonic neuroendocrine tumors

  • 摘要:
    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。

     

    Abstract:
    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.

     

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