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T1～2N0M0期十二指肠神经内分泌肿瘤患者内镜治疗与手术治疗的生存差异

Survival differences between endoscopic treatment and surgical treatment for patients with T1-2N0M0 duodenal neuroendocrine tumor

    摘要
  • 摘要:
    目的 比较T1～2N0M0期十二指肠神经内分泌肿瘤（duodenal neuroendocrine tumor，DNET）患者内镜下切除（endoscopic resection，ER）与手术切除（surgical resection，SR）后的长期生存情况。
    方法 从SEER数据库中收集2004年1月1日至2015年12月31日诊断为T1～2N0M0期DNET患者的临床资料。采用Kaplan-Meier生存曲线和log-rank检验比较ER组与SR组DNET患者的总生存（overall survival，OS）率、肿瘤特异性生存（cancer-specific survival，CSS）率。采用倾向评分匹配（propensity score matching，PSM）分析减少两组间临床病理特征的差异。采用多因素Cox回归分析评估PSM前与PSM后DNET患者OS和CSS的相关影响因素。
    结果 共纳入656例DNET患者，包括ER组457例、SR组199例。PSM前，ER组和SR组患者5年OS率差异无统计学意义（88.9% vs 89.6%），5年CSS率差异有统计学意义（99.3% vs 96.9%，P＝0.017）。PSM前，Cox多因素回归分析显示，年龄增加是患者OS期缩短的独立危险因素（P＜0.001），治疗方式（ER与SR）不是患者OS及 CSS的独立影响因素。PSM后，ER组（n＝187）和SR组（n＝187）DNET患者5年OS率（90.2% vs 88.9%）和CSS率（98.9% vs 96.7%）差异均无统计学意义。PSM后，Cox多因素回归分析显示，年龄增加是患者OS期缩短的独立危险因素（P＜0.001），治疗方式（ER与SR）不是患者OS及 CSS的独立影响因素。
    结论 T1～2N0M0期DNET患者内镜治疗与手术治疗后的OS和CSS相似；年龄增加独立影响DNET患者的OS。

     

    Abstract:
    Objective To compare the long-term survival outcomes of patients with T1-2N0M0 duodenal neuroendocrine tumor (DNET) after endoscopic resection (ER) or surgical resection (SR).
    Methods Patients diagnosed with T1-2N0M0 DNET between January 1, 2004, and December 31, 2015, were extracted from the SEER database. Kaplan-Meier survival curve and log-rank test were used to compare overall survival (OS) rate and cancer-specific survival (CSS) rate between patients undergoing ER or SR. Propensity score matching (PSM) was used to reduce grouping differences, and multivariate Cox regression was used to analyze factors affecting OS and CSS before and after PSM.
    Results A total of 656 patients were included, with 457 in ER group and 199 in SR group. Before PSM, there was no significant difference in the 5-year OS rate between the ER and SR groups (88.9% vs 89.6%), but there was a significant difference in the 5-year CSS rate (99.3% vs 96.9%, P＝0.017). Before PSM, multivariate Cox regression analysis showed advanced age was an independent risk factor for decreased OS (P＜0.001). After PSM, there was no significant difference between the ER group (n＝187) and SR group (n＝187) in 5-year OS rate (90.2% vs 88.9%) or CSS rate (98.9% vs 96.7%). After PSM, multivariate Cox regression also showed advanced age was an independent risk factor for decreased OS, while resection method was not an independent factor for OS or CSS.
    Conclusions There is no significant difference in OS or CSS after endoscopic treatment and surgical treatments for patients with T1-2N0M0 DNET, and advanced age is an independent factor for OS.

     

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