摘要
目的探讨不同分期结肠神经内分泌肿瘤(NEN)和直肠NEN患者预后的差异。方法从美国监测、流行病学与最终结果数据库(SEER)中选取1988-2014年经病理明确诊断为结直肠NEN的患者8679例,其中直肠NEN 5437例,结肠NEN3242例(其中盲肠NEN1681例)。采用Kaplan-Meier法绘制生存曲线,采用单因素分析和多因素Cox回归模型分析结直肠NEN患者的预后影响因素。结果直肠NEN和结肠NEN患者男女比例相似(P=0.095),直肠NEN患者的发病年龄偏小(P<0.001)、高分化患者较多(P<0.001)、临床分期偏早(P<0.001)。生存分析显示,直肠NEN患者生存优于结肠NEN患者,10年肿瘤特异性生存率分别为86.8%和44.8%(P<0.001)。多因素Cox回归分析显示,性别、年龄、婚姻状态、原发肿瘤部位、肿瘤分化程度、肿瘤分期及是否手术是结直肠NEN患者预后的独立影响因素(均P<0.01),其中最重要的影响因素是肿瘤分期(HR=3.531),其次是肿瘤分化程度(HR=1.856)。按照肿瘤分期分层的多因素Cox回归分析结果显示,Ⅰ期、Ⅱ期、Ⅳ期患者中,直肠NEN患者生存优于结肠NEN患者(均P<0.05);而Ⅲ期患者中,结肠NEN患者生存优于直肠NEN患者(P=0.012)。剔除1 681例盲肠NEN患者后,不同分期患者中均为直肠NEN患者生存优于结肠NEN患者(均P<0.05)。按照肿瘤分期和分化程度分层的多因素Cox回归分析结果显示,分化好组Ⅰ期、Ⅲ期、Ⅳ期患者中,直肠NEN患者生存优于结肠NEN患者(均P<0.05);而分化好组Ⅱ期患者中,直肠和结肠NEN患者生存差异无统计学意义(P=0.169)。分化差组Ⅳ期患者中,直肠NEN患者生存优于结肠NEN患者(P=0.001);而分化差组Ⅰ期、Ⅱ期、Ⅲ期患者中,直肠和结肠NEN患者生存差异无统计学意义(Ⅰ期:P=0.760;Ⅱ期:P=0.181;Ⅲ期:P=0.313)。结论结肠与直肠NEN患者生存存在差异。盲肠NEN具有独特的肿瘤生物学特性,在研究结肠NEN时,宜将其作为一种独立部位肿瘤来分析。
Objective To explore the survival difference of patients with colon and rectal neuroendocrine neoplasm (NEN) at different stages. Methods We identified 8 679 patients with colorectal NEN diagnosed between 1988 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) registry, including 5 437 rectal NEN and 3 242 colon NEN ( 1 681 cecum NEN ). Survival curve was drawn by Kaplan-Meier method. Prognostic factors were analyzed by univariate analysis and multivariate Cox regression model. Results The ratio of male patients with colon and rectal NEN was similar to female (P=0.095). Rectal NEN patients were younger (P<0.001), more highly differentiated (P<0.001), and with earlier stage (P<0.001). Survival analysis showed that the survival of rectal NEN was superior to that of colon NEN, with 10-year tumor-specific survival rates of 86.8% and 44.8% respectively (P<0.001). Multivariate Cox analysis showed that age, gender, marital status, primary tumor site, grade, stage and surgery were independent prognostic factors of colorectal NEN (all P<0.01). The most important factor was stage (HR=3.531), followed by differentiation grade (HR=1.856). Stratified analysis displayed that the survival of rectal NEN in stage Ⅰ,Ⅱ and Ⅳ were better than those of corresponding stage of colon NEN (all P<0.05), but worse in stage Ⅲ(P=0.012). While the survival of rectal NEN were significantly better than those of colon NEN within all stages after excluding 1681 cases of cecal NEN (all P<0.05). Among the patients with well-differentiated NEN, the survival of rectal NEN in stage Ⅰ,Ⅲ and Ⅳ were better than those of corresponding stage of colon NEN (all P<0.05) while there was no significant difference in stage Ⅱ(P=0.169). For poor-differentiated NEN, only the survival of rectal NEN patients in stage Ⅳ(P=0.001) was significant longer than those of colon NEN, while there was no significant difference in stage Ⅰ,Ⅱ and Ⅲ(stage Ⅰ: P=0.760;stage Ⅱ: P=0.181;stage Ⅲ: P=0.313). Conclusions The survival of NEN patients in colon and rectum is different. Cecum NEN should be considered as a separated tumor for prognostic analysis due to its special clinicopathologic characteristics.
作者
黄玉庭
贾茹
徐倩
冀寿健
崔鹤滕
徐建明
Huang Yuting;Jia Ru;Xu Qian;Ji Shoiijian;Cui Heteng;Xu Jianming(Department of Gastrointestinal Oncology, the 307th Hospital of the Chinese People's Liberation Army, Beijing 100071, China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2019年第2期146-151,共6页
Chinese Journal of Oncology
关键词
神经内分泌肿瘤
结肠
直肠
分期
预后
Neuroendocrine neoplasm
Colon
Rectum
Classification
Prognosis
