Hospices Civils de Lyon, Hôpital Edouard Herriot, Service Central d'Anatomie et Cytologie Pathologiques, 69437 Lyon cedex 03, France.
University of Lyon, Université Lyon 1, France.
Sci Rep. 2017 Jan 11;7:40609. doi: 10.1038/srep40609.
Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are a very aggressive type of cancer, for which prognostic factors are lacking. We analysed clinical and histomorphological prognostic markers of overall survival (OS), completed with a record of biological and haematological data of patients diagnosed between December 2002 and December 2015. The median OS was 16 months (95% CI 13.9-18.1). After univariate analysis, performance status (PS) ≥ 2 and stage IV were associated with a worse outcome (9 months and 14 months, respectively), as well as patients with lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels ≥ 2 ULN (9 months and 8 months, respectively). After multivariate analysis, LDH and AST levels were the only factors that remained significantly associated with better survival: HR 0.36 (p = 0.04) and 0.31 (p = 0.03), respectively. When patients had elevated LDH and AST levels, OS was 20 months, when they had high LDH or AST levels, 13 months and 8 months in the group with low LDH and AST levels (p < 0.001). Therefore, biological data appeared to be more relevant prognostic factors than usual factors described in other studies (PS, stage, and Ki-67). Considering LDH and AST levels at diagnosis could help physicians to predict survival and to stratify patients for clinical trials.
胃肠胰神经内分泌癌（GEP-NEC）是一种非常侵袭性的癌症，目前缺乏预后因素。我们分析了 2002 年 12 月至 2015 年 12 月期间诊断的患者的临床和组织形态学总生存（OS）预后标志物，并记录了患者的生物学和血液学数据。中位 OS 为 16 个月（95%CI 13.9-18.1）。单因素分析后，表现状态（PS）≥2 和 IV 期与预后较差相关（分别为 9 个月和 14 个月），乳酸脱氢酶（LDH）和天冬氨酸转氨酶（AST）水平≥2 倍正常值上限（ULN）的患者也与预后较差相关（分别为 9 个月和 8 个月）。多因素分析后，仅 LDH 和 AST 水平与更好的生存相关：HR 0.36（p=0.04）和 0.31（p=0.03）。当患者 LDH 和 AST 水平升高时，OS 为 20 个月；当 LDH 和 AST 水平较高时，OS 分别为 13 个月和 8 个月，而 LDH 和 AST 水平较低时，OS 为 8 个月（p<0.001）。因此，与其他研究中描述的常用因素（PS、分期和 Ki-67）相比，生物学数据似乎是更相关的预后因素。考虑诊断时的 LDH 和 AST 水平可能有助于医生预测生存并为临床试验分层患者。
