邮件订阅 RSS 中文 | English
高级检索

T1~2期胃神经内分泌肿瘤转移的影响因素以及患者内镜和手术治疗后生存差异分析

Analysis of influencing factors of metastasis and survival difference after endoscopic and surgical treatment in patients with gastric neuroendocrine tumors in stage T1-2

    摘要
  • 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。

     

    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 mmmight 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.

     

    • HTML全文
    • 参考文献(14)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回