摘要: |
目的 探讨T1~2期胃神经内分泌肿瘤(G-NETs)患者的转移率及其相关危险因素,比较其内镜治疗(ET)和手术治疗后长期生存结果。方法 分析SEER数据库数据,纳入2004年1月1日至2015年12月31日病理学诊断为G-NETs的患者1 258例。采用logistic回归分析G-NETs患者肿瘤转移的影响因素。在T1~2N0M0期G-NETs患者中,采用倾向性评分匹配分析,比较匹配后接受ET与手术治疗患者的一般临床特征,采用Kaplan-Meier生存曲线和Cox比例风险模型分析两组患者总生存期(OS)差异和影响OS的危险因素。结果 1 258例G-NETs患者中,851例随访5年,有183例(21.5%)发生了淋巴结或远处转移,其中T1期(n=78)、T2期(n=105)患者的转移率分别为14.6%和33.3%(P<0.05)。多因素logistic回归分析发现,肿瘤组织分级G3/4、浸润固有肌层及肿瘤最大径>20 mm与T1~2期G-NETs患者发生转移相关(P<0.05)。非转移组(n=668)患者5年生存率为85.1%,转移组(n=183)患者5年生存率为34.7%(P<0.05)。随访5年时发生远处转移的患者手术和ET治疗后平均生存期为42.0个月和31.3个月(χ2=14.510,P<0.05);未发生远处转移的患者手术和ET治疗后平均生存期分别为53.2个月和52.3个月(χ2=0.279,P=0.598)。倾向性匹配分析后,T1~2N0M0期G-NETs患者ET(n=279)与手术(n=279)治疗后5年生存率相似(88.8%vs 89.4%;χ2=0.220,P=0.882);Cox比例风险模型结果显示,年龄、肿瘤组织学分级、浸润深度与该类患者OS相关。结论 肿瘤组织分级G3/4、浸润固有肌层及肿瘤最大径>20 mm与T1~2期G-NETs患者发生转移显著相关;发生远处转移的T1~2期G-NETs患者预后较差。T1~2N0M0期G-NETs患者ET与手术治疗后的OS无显著差异。 |
关键词: 胃神经内分泌肿瘤 内镜治疗 手术治疗 SEER数据库 |
DOI:10.12025/j.issn.1008-6358.2023.20221846 |
分类号:R735.2 |
基金项目:上海市2021年度“科技创新行动计划”医学创新研究专项(21Y11913100),上海市宝山区科学技术委员会科技创新专项资金(2023-E-19). |
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Analysis of influencing factors of metastasis and survival difference after endoscopic and surgical treatment in patients with gastric neuroendocrine tumors in stage T1-2 |
BAI Bin1, LI Heng1, WANG Jun1, JIANG Wei-ting1, ZHU Xu-jun1, XU Jian1, CAI Hui2
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1.Department of Gastrointestinal Surgery, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201900, China;2.Department of General Surgery, the First Affiliated Hospital, Naval Medical University, Shanghai 200433, China
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Abstract: |
Objective To explore the metastasis rate of gastric neuroendocrine tumors (G-NETs) patients in stage T1-2 and its related risk factors, and to compare the long-term survival results of patients after endoscopic therapy (ET) and surgical treatment. Methods The data in SEER database were analyzed, and 1 258 patients with pathologically diagnosed G-NETs from January 1, 2004 to December 31, 2015 were included. Logistic regression was used to analyze the influencing factors of metastasis of patients with G-NETs. In patients with T1-2N0M0 stage G-NETs, the general clinical characteristics of patients receiving ET or surgery were compared after propensity matching analysis. The difference of 5-year overall survival (OS) and the risk factors affecting OS between the surgery and ET groups were analyzed by Kaplan-Meier survival curve and Cox proportional hazard regression model. Results A total of 851 patients with T1 and T2 G-NETs were followed up for 5 years. Lymph node or distant metastasis occurred in 183 patients (21.5%). The metastasis rates of T1 and T2 G-NETs patients were 14.6% and 33.3%, respectively (P<0.05). Multivariate logistic regression analysis showed that tumor grade G3/4, invasion of lamina propria and tumor diameter >20 mm were closely related to metastasis of T1-2 stage G-NETs. The 5-year survival rate of patients in non-metastasis group (n=668) was 85.1%, and that of patients in metastasis group (n=183) was 34.7% (P<0.05). Subgroup analysis showed that during the 5-year follow-up, the average survival time of patients with metastasis after surgery and ET treatment was 42.0 months and 31.3 months (χ2=14.510, P<0.05), and the average survival time of patients without metastasis after surgery and ET treatment was 53.2 months and 52.3 months (χ2=0.279, P=0.598). After propensity matching analysis, the 5-year survival rate of patients with T1-2N0M0 G-NETs was similar after ET and surgery (88.8% vs 89.4%, χ2=0.22, P=0.882). Multivariate Cox proportional hazard regression model showed that age, histological grade and depth of invasion were related to OS of patients with T1-2N0M0 G-NETs. Conclusions The tumor grade G3/4, invasion of lamina propria and tumor diameter > 20 mm might be closely related to the metastasis of G-NET in T1-2 stage, the prognosis of these patients with metastasis is poor. 5-year survival rate in patients with T1~2N0M0 G-NETs are similar after ET and surgery. |
Key words: gastric neuroendocrine tumors endoscopic therapy surgery SEER database |