淋巴结比率可优化小肠神经内分泌肿瘤患者的分期。

The Lymph Node Ratio Optimizes Staging in Patients with Small Intestinal Neuroendocrine Tumors.

机构信息

Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.

Institution of Gastroenterology, Zhejiang University, Hangzhou, China.

出版信息

Neuroendocrinology. 2018;107(3):209-217. doi: 10.1159/000491017. Epub 2018 Jun 19.

DOI:10.1159/000491017

PMID:29920478

Abstract

BACKGROUND

The effectiveness of the current Tumor, Lymph node, Metastases (TNM) staging system in small intestinal neuroendocrine tumors (SiNETs) is unsatisfactory. Current N classification only distinguishes between node-negative and node-positive status. We aim to refine the N classification for updated TNM stage.

METHODS

During the period from 1988 to 2012, patients with non-metastatic -SiNETs were enrolled in the Surveillance, Epidemiology, and End Results database. Using the X-tile program, we calculated an optimal cutoff value for lymph node ratio (LNR) and proposed a novel Nr category. Survival outcomes were estimated using the Kaplan-Meier method and Cox regression model. Adjusted hazard ratio (HR) and cluster analysis were performed to differentiate TNrM stages.

RESULTS

Patients with existing TNM stage I and II had equivalent survival prognosis (p = 0.214). Current N classification was not a significant predictor of patient survival (p = 0.372). Multivariate analyses identified the revised Nr classification, based on LNR of 0.6 optimal cutoff value, as an independent prognostic factor (p = 0.020). By incorporating the Nr classification, a revised TNrM, which categorized patients into 3 new stages was proposed: stage I (T1-2Nr0-1), stage II (T3Nr0-1), and stage III (TxNr2 or T4Nrx). TNrM stage had better stratification according to the survival outcome (primary cohort: stage I: reference, II: HR 3.852, 95% CI 1.731-8.575; III: HR 7.169, 95% CI 3.220-15.963, p < 0.001; validation cohort: stage I: reference, II: HR 2.034; III: HR 3.815; p < 0.001).

CONCLUSIONS

The Nr classification more accurately stratifies SiNET patients than current N classification. The new TNrM staging system could improve the ability to predict survival outcome of SiNET patients.

摘要

背景

目前的肿瘤、淋巴结、转移（TNM）分期系统在小肠神经内分泌肿瘤（SiNETs）中的效果并不令人满意。目前的 N 分类仅区分淋巴结阴性和淋巴结阳性状态。我们旨在完善 N 分类，以更新 TNM 分期。

方法

在 1988 年至 2012 年期间，将患有非转移性 SiNETs 的患者纳入监测、流行病学和最终结果数据库。使用 X-tile 程序，我们计算了淋巴结比率（LNR）的最佳截断值，并提出了一个新的 Nr 类别。使用 Kaplan-Meier 方法和 Cox 回归模型估计生存结果。使用调整后的危险比（HR）和聚类分析来区分 TNrM 分期。

结果

现有 TNM 分期 I 期和 II 期的患者具有相同的生存预后（p=0.214）。目前的 N 分类不是患者生存的显著预测因素（p=0.372）。多变量分析确定了基于 0.6 最佳截断值的 LNR 的修订 Nr 分类是独立的预后因素（p=0.020）。通过纳入 Nr 分类，提出了一种新的 TNrM，将患者分为 3 个新的阶段：I 期（T1-2Nr0-1）、II 期（T3Nr0-1）和 III 期（TxNr2 或 T4Nrx）。根据生存结果，TNrM 分期具有更好的分层（主要队列：I 期：参考，II 期：HR 3.852，95%CI 1.731-8.575；III 期：HR 7.169，95%CI 3.220-15.963，p<0.001；验证队列：I 期：参考，II 期：HR 2.034；III 期：HR 3.815；p<0.001）。