Ahmed A, Turner G, King B, Jones L, Culliford D, McCance D, Ardill J, Johnston B T, Poston G, Rees M, Buxton-Thomas M, Caplin M, Ramage J K
Basingstoke and North Hampshire Foundation Trust, Basingstoke, UK.
Endocr Relat Cancer. 2009 Sep;16(3):885-94. doi: 10.1677/ERC-09-0042. Epub 2009 May 20.
We intended to identify the prognostic factors and the results of interventions on patients with liver metastatic midgut carcinoids. Five institutions that are part of United Kingdom and Ireland neuroendocrine tumour (NET) group took part in this study. Patients were included if they had histology proven NET of midgut origin and liver metastases at the time of the study. Clinical and biochemical data were collected retrospectively from hospital charts, pathology reports, radiology reports and biochemistry records for each patient. Three hundred and sixty patients were included in the study. The median survival from date of diagnosis was 7.69 years (confidence interval (CI) 6.40-8.99) and 5.95 years (CI 5.02-6.88) from date of diagnosis of liver metastases. On univariate analysis, increasing age at diagnosis, increasing urinary hydroxyindole acetic acid levels, increasing plasma chromogranin A levels, high Ki67, high tumour volume and treatment with chemotherapy were identified as factors associated with a significantly poorer outcome. Resection of liver metastases, resection of small bowel primary, treatment with somatostatin analogue therapy and treatment with peptide receptor therapy were associated with improved prognosis. Multivariate analysis revealed that age at diagnosis (P=0.014), Ki67 level (P=0.039) and resection of primary (P=0.015) were independent predictors of survival. This is the largest study to our knowledge looking specifically at the prognosis and clinical course of patients with liver metastatic midgut NETs. For the first time, we have shown that Ki67 and resection of primary are independent predictors of survival for this group of patients.
我们旨在确定肝转移性中肠类癌患者的预后因素及干预结果。英国和爱尔兰神经内分泌肿瘤（NET）组的五家机构参与了本研究。若患者在研究时经组织学证实为中肠起源的NET且伴有肝转移，则纳入研究。临床和生化数据通过回顾性收集每位患者的医院病历、病理报告、放射学报告及生化记录获得。360例患者纳入本研究。从诊断日期起的中位生存期为7.69年（置信区间（CI）6.40 - 8.99），从肝转移诊断日期起为5.95年（CI 5.02 - 6.88）。单因素分析显示，诊断时年龄增加、尿羟吲哚乙酸水平升高、血浆嗜铬粒蛋白A水平升高、高Ki67、肿瘤体积增大及化疗治疗被确定为与预后显著较差相关的因素。肝转移灶切除、小肠原发灶切除、生长抑素类似物治疗及肽受体治疗与预后改善相关。多因素分析显示，诊断时年龄（P = 0.014）、Ki67水平（P = 0.039）及原发灶切除（P = 0.015）是生存的独立预测因素。据我们所知，这是专门针对肝转移性中肠NET患者预后和临床病程的最大规模研究。首次表明，Ki67和原发灶切除是该组患者生存的独立预测因素。
