Bachelor of Nursing, Special Medical Department, The Sixth Medical Center of People's Liberation Army General Hospital (The Former Naval General Hospital of PLA), Beijing, People's Republic of China.
Special Medical Department, The Sixth Medical Center of People's Liberation Army General Hospital (The Former Naval General Hospital of PLA), Beijing, People's Republic of China.
Clin Interv Aging. 2019 Aug 6;14:1419-1432. doi: 10.2147/CIA.S209428. eCollection 2019.
To investigate the effect of primary site surgery (PSS) on elderly patients (≥65 years) with pancreatic neuroendocrine tumor (pNET) distant metastasis.
We reviewed Surveillance Epidemiology and the End Results database for elderly patients with distant pNET from 1973 to 2015. The variables and survival outcomes of patients with PSS were compared with that of patients with no PSS. After propensity score matching, the survival outcome was compared again between the two groups. Multivariable Cox proportional hazard model was used to identify variables associated with cancer-specific and overall survival. Four sub-groups were divided according to the age and differentiation: 1) age 65-74 years+ well or moderately differentiated; 2) age ≥75 years+ well or moderately differentiated; 3) age 65-74 years+ poorly differentiated or undifferentiated; and 4) age ≥75 years+ poorly differentiated or undifferentiated. Cancer-specific survival was compared between the patients with and without PSS in the above each group.
A total of 210 elderly patients with distant pNET were finally confirmed. Of which, 148 patients did not undergo PSS, while 62 patients underwent PSS. Being female (=0.049), locating on body/tail of pancreas (=0.006), and well or moderately differentiated (=0.032) were more likely received PSS. The patients underwent PSS had better survival outcomes both before and after propensity score matching. Multivariable Cox proportional hazard analysis proves PSS and higher histological grade to be protective and risk factors. PSS may improve cancer specific survival in patients of group 1), and no improvement was observed in patients of the other three sub-groups.
Not all elderly patients with pNET distant metastasis could benefit from PSS. Patients aged 65-74 years with well or moderately differentiated may benefit from primary lesion surgery, but should be evaluated carefully. Prospective randomized controlled trials are worth performing.
探讨原发灶切除术（PSS）对伴有远处转移的老年胰腺神经内分泌肿瘤（pNET）患者的影响。
我们回顾了 1973 年至 2015 年间，来自监测、流行病学和最终结果（SEER）数据库的伴有远处 pNET 的老年患者资料。比较了行 PSS 与未行 PSS 患者的临床特征及生存情况。采用倾向性评分匹配（PSM）后再次比较两组患者的生存情况。采用多因素 Cox 比例风险模型分析与肿瘤特异性及总生存相关的因素。根据年龄和分化程度将患者分为 4 个亚组：1）年龄 65-74 岁+高或中分化；2）年龄≥75 岁+高或中分化；3）年龄 65-74 岁+低分化或未分化；4）年龄≥75 岁+低分化或未分化。比较各亚组中行 PSS 与未行 PSS 患者的肿瘤特异性生存情况。
共纳入 210 例伴有远处转移的老年 pNET 患者，其中 148 例未行 PSS，62 例行 PSS。行 PSS 的患者女性（P=0.049）、肿瘤位于胰体尾部（P=0.006）、高或中分化（P=0.032）的比例更高。行 PSS 可改善患者的生存情况，且 PSM 前后均如此。多因素 Cox 比例风险分析显示，PSS 和高组织学分级是保护因素和危险因素。PSS 可能改善 1 组患者的肿瘤特异性生存，而在其他 3 个亚组中未观察到改善。
并非所有伴有远处转移的老年 pNET 患者均能从 PSS 中获益。年龄 65-74 岁且高或中分化的患者可能从原发灶手术中获益，但应仔细评估。值得开展前瞻性随机对照临床试验。
