Li Gang, Tian Mao-Lin, Bing Yun-Tao, Tao Lian-Yuan, Wang Hang-Yan, Jiang Bin, Yuan Chun-Hui, Xiu Dian-Rong
Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China.
Medicine (Baltimore). 2019 Mar;98(11):e14576. doi: 10.1097/MD.0000000000014576.
To investigate the features and prognosis of the elderly patients with pancreatic neuroendocrine tumor (pNET).The patients diagnosed with pNETs between 2004 and 2014 were identified from the Surveillance Epidemiology and End Results database. The ethical approval was waived because the present study was analysis of the data from Surveillance Epidemiology and End Results database.A total of 4608 patients with "one primary only" histologically pNETs were confirmed and 653 were older than 75 years. Cancer-specific survival (CSS) and overall survival (OS) were examined. The elderly patients (≥75 years) have disadvantage in CSS and OS compared with younger cohort. Multivariate logistic regression revealed that the elderly patients have increased poorly differentiated composition, and decreased proportion of Black patients, receipt of surgery, married status, and number of removed lymph node. Multivariate Cox regression analysis demonstrated worse differentiation. Patients of T3-4 and M1 stage were associated with poor CSS, while patients of being female, tumor locating at pancreatic body/tail, receipt of surgery, and being married were associated with better CSS in the elderly patients. Meanwhile, patients with higher histological grade and M1 stage have poor OS, while patients with the characteristics of female, being married, tumor location at pancreatic body/tail and tumor surgery have better OS. Distant metastatic elderly patients underwent primary site surgery had better CSS and OS than the patients without surgery.The elderly patients have increased possibility of poorly differentiated tumor, and decreased proportion of Black patients, surgery of primary site, number of removed lymph node and married status. Worse differentiation and tumor metastasis were independent risk factors for both CSS and OS, while primary tumor located in body/tail of pancreas, female patients, surgery of tumor primary site, and being married were protective factors.
探讨老年胰腺神经内分泌肿瘤(pNET)患者的特征及预后。从监测、流行病学和最终结果数据库中识别出2004年至2014年间诊断为pNET的患者。由于本研究是对监测、流行病学和最终结果数据库的数据进行分析,因此无需伦理批准。共确认4608例组织学上为“仅一个原发灶”的pNET患者,其中653例年龄超过75岁。对癌症特异性生存(CSS)和总生存(OS)进行了研究。与年轻队列相比,老年患者(≥75岁)在CSS和OS方面处于劣势。多因素逻辑回归显示,老年患者低分化成分增加,黑人患者比例、接受手术情况、婚姻状况及切除淋巴结数量减少。多因素Cox回归分析显示分化更差。T3 - 4期和M1期患者的CSS较差,而女性、肿瘤位于胰体/尾部、接受手术及已婚的老年患者CSS较好。同时,组织学分级较高和M1期患者的OS较差,而具有女性、已婚、肿瘤位于胰体/尾部及肿瘤手术特征的患者OS较好。远处转移的老年患者接受原发部位手术的CSS和OS优于未手术患者。老年患者肿瘤低分化的可能性增加,黑人患者比例、原发部位手术、切除淋巴结数量及婚姻状况降低。分化差和肿瘤转移是CSS和OS的独立危险因素,而原发肿瘤位于胰体/尾部、女性患者、肿瘤原发部位手术及已婚是保护因素。