接受手术治疗的高级别胰腺神经内分泌癌患者的生存情况：两种美国癌症联合委员会第 8 版肿瘤-淋巴结-转移分期系统的比较研究。

Survivals of patients with surgically treated and High-grade pancreatic neuroendocrine carcinomas: A comparative study between two American Joint Committee on Cancer 8th tumor-node-metastasis staging systems.

机构信息

Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, PR China.

Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, PR China.

出版信息

Eur J Surg Oncol. 2019 Jun;45(6):1054-1060. doi: 10.1016/j.ejso.2019.01.010. Epub 2019 Jan 11.

DOI:10.1016/j.ejso.2019.01.010

PMID:30661921

Abstract

BACKGROUND AND OBJECTIVE

We aimed to compare the two new defined tumor-node-metastasis (TNM) systems in the American Joint Committee on Cancer (AJCC) 8th staging manual for overall survival (OS) analysis of G3 pancreatic neuroendocrine carcinomas (p-NECs) that are currently proposed for pancreatic exocrine adenocarcinomas (p-EACs) and G1/G2 pancreatic neuroendocrine tumors (p-NETs), respectively.

METHODS

The data of patients who were surgically treated and histopathologically diagnosed with G3 p-NECs at West China Hospital of Sichuan University from January 2002 to June 2017 were retrospectively analyzed and compared using the two new AJCC staging systems.

RESULTS

Applying the p-EAC AJCC 8th TNM staging system to G3 p-NECs, the estimated 3-year OSs for each stage were 86.7%, 76.0%, 44.5% and 20.7%, respectively (P < 0.001). According to the G1/G2 p-NETs staging system, the estimated OSs at 3 years for each new AJCC stage were 100.0%, 83.6%, 47.1% and 20.7%, respectively (P < 0.001). The system for p-EACs significantly discriminated the survival difference of G3 p-NECs between Stage I and Stage II (P = 0.019), while the other one for G1/G2 p-NETs could not (P = 0.108). The consistent results of Akaike information criteria with Harrell's concordance index indicated that the AJCC 8th staging system for p-EACs was superior when applied to G3 p-NECs for its better prognostic stratification and more accurate prediction ability for OS.

CONCLUSIONS

Our analysis demonstrated that both TNM systems in the AJCC 8th staging manual were prognostic for patients with G3 p-NECs; however, the classification originally applied to p-EACs was superior and supported its use in clinical practice.

摘要

背景与目的

我们旨在比较美国癌症联合委员会（AJCC）第 8 版分期手册中两种新定义的肿瘤-淋巴结-转移（TNM）系统，用于分析目前分别适用于胰腺外分泌腺癌（p-EAC）和 G1/G2 胰腺神经内分泌肿瘤（p-NET）的 G3 胰腺神经内分泌癌（p-NEC）的总生存（OS）。

方法

回顾性分析 2002 年 1 月至 2017 年 6 月在四川大学华西医院接受手术治疗并经组织病理学诊断为 G3 p-NEC 的患者数据，并使用两种新的 AJCC 分期系统进行比较。

结果

将 p-EAC AJCC 第 8 版 TNM 分期系统应用于 G3 p-NEC，各期的估计 3 年 OS 分别为 86.7%、76.0%、44.5%和 20.7%（P<0.001）。根据 G1/G2 p-NET 分期系统，各新 AJCC 分期的估计 3 年 OS 分别为 100.0%、83.6%、47.1%和 20.7%（P<0.001）。p-EAC 系统显著区分了 G3 p-NEC 在 I 期和 II 期之间的生存差异（P=0.019），而另一个用于 G1/G2 p-NET 的系统则不能（P=0.108）。Akaike 信息准则与 Harrell 一致性指数的一致结果表明，当应用于 G3 p-NEC 时，p-EAC 的 AJCC 第 8 版分期系统在预后分层和 OS 预测能力方面更优。