胃类癌：手术类型或肿瘤是否影响生存？

Gastric carcinoids: Does type of surgery or tumor affect survival?

机构信息

Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.

Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.

出版信息

Am J Surg. 2019 May;217(5):937-942. doi: 10.1016/j.amjsurg.2018.12.057. Epub 2018 Dec 28.

DOI:10.1016/j.amjsurg.2018.12.057

PMID:30686481

Abstract

BACKGROUND

Gastric carcinoids are rare neuroendocrine tumors of the gastrointestinal tract. They are typically managed according to their etiology. However, there is little known about the impact of surgical strategy on the long-term outcomes of these patients.

METHODS

All patients who underwent resection of gastric carcinoids at 8 institutions from 2000 to 2016 were analyzed retrospectively. Tumors were stratified according to subtype (I, II, III, IV) and resection type (local resection, LR or formal gastrectomy, FG). Clinicopathological parameters, recurrence-free (RFS) and overall survival (OS) were compared between groups.

RESULTS

Of 79 patients identified with gastric carcinoids, 34 had type I lesions associated with atrophic gastritis, 4 had type II lesions associated with a gastrinoma, 37 had type III sporadic lesions, and 4 had type IV poorly-differentiated lesions. The mean age of presentation was 56 years in predominantly Caucasian (77%) and female (63%) patients. Mean tumor size was 2.4 cm and multifocal tumors were found in 24 (30%) of patients with the majority occurring in those with type I tumors. Lymph node positive tumors were seen in 15 (19%) patients and 7 (8%) had M1 disease; both most often in type IV followed by type III tumors. R0 resection was achieved in 56 (71%) patients while 15 (19%) had R1 resections and 6 (8%) R2 resections. Patients with type I and III tumors were equally likely to have a LR (50% and 43% respectively) compared to FG while those with type II and IV all had FG with one exception. Type IV tumors had the poorest RFS and OS while Type II tumors had the most favorable RFS and OS (p < 0.04 and p < 0.0004, respectively). While there was no difference in RFS in those patients undergoing FG versus LR, OS was worse in the FG group (p < 0.017). This trend persisted when type II and type IV groups were excluded (p < 0.045).

CONCLUSION

Gastric carcinoid treatment should be tailored to tumor type, as biologic behavior rather than resection technique is the more important factor contributing to long-term outcomes.

摘要

背景

胃类癌是胃肠道罕见的神经内分泌肿瘤。它们通常根据病因进行治疗。然而，对于手术策略对这些患者的长期预后的影响知之甚少。

方法

回顾性分析了 2000 年至 2016 年 8 家医院接受胃类癌切除术的所有患者。根据亚型（I、II、III、IV）和切除类型（局部切除 LR 或根治性胃切除术 FG）对肿瘤进行分层。比较组间临床病理参数、无复发生存率（RFS）和总生存率（OS）。

结果

在 79 例胃类癌患者中，34 例为与萎缩性胃炎相关的 I 型病变，4 例为与胃泌素瘤相关的 II 型病变，37 例为 III 型散发性病变，4 例为 IV 型低分化病变。患者以白种人为主（77%），女性居多（63%），平均年龄为 56 岁。平均肿瘤大小为 2.4cm，24 例（30%）患者有多发性肿瘤，主要发生在 I 型肿瘤患者中。15 例（19%）患者肿瘤淋巴结阳性，7 例（8%）患者 M1 期；这两种情况最常见于 IV 型，其次是 III 型肿瘤。56 例（71%）患者行 R0 切除术，15 例（19%）患者行 R1 切除术，6 例（8%）患者行 R2 切除术。与 FG 相比，I 型和 III 型肿瘤患者行 LR 的可能性相同（分别为 50%和 43%），而 II 型和 IV 型肿瘤患者均行 FG，仅有一例例外。IV 型肿瘤的 RFS 和 OS 最差，而 II 型肿瘤的 RFS 和 OS 最佳（p<0.04 和 p<0.0004）。虽然 FG 与 LR 患者的 RFS 无差异，但 FG 组的 OS 更差（p<0.017）。当排除 II 型和 IV 型组时，这种趋势仍然存在（p<0.045）。