直肠神经内分泌肿瘤大病例队列的研究结果：国家癌症数据库分析。
Outcomes for a Large Cohort of Patients with Rectal Neuroendocrine Tumors: an Analysis of the National Cancer Database.
机构信息
Department of Surgery, Division of Colon and Rectal Surgery, University of California, San Diego, John and Rebecca Moores Cancer Center, 3855 Health Sciences Dr. #0987, La Jolla, CA, 92037, USA.
出版信息
J Gastrointest Surg. 2021 Feb;25(2):484-491. doi: 10.1007/s11605-020-04525-6. Epub 2020 Feb 3.
BACKGROUND
Rectal neuroendocrine tumors comprise 20% of neuroendocrine tumors in the alimentary tract, but there is controversy surrounding the optimal management of this disease. The purpose of this study is to better define treatment for patients with rectal neuroendocrine tumors.
METHODS
Using the National Cancer Database, we analyzed patients with rectal neuroendocrine tumors between 2004 and 2015. Patients with metastatic disease and missing treatment data were excluded. We examined overall survival stratified by tumor size, treatment type, and presence of positive lymph nodes using Kaplan-Meier analysis with log-rank test. Cox proportional hazard regression model was performed to identify factors associated with overall survival.
RESULTS
In total, 17,448 patients with rectal neuroendocrine tumors were identified; 16,531 of these patients met inclusion criteria. The majority of patients had tumors ≤ 10 mm (9216 patients, 79.8%), and approximately 90% underwent local excision. The probability of 5-year overall survival was significantly higher for patients with smaller tumors (≤ 10 mm: 94.1% 11-20 mm: 85.7%, > 20 mm: 71.8%; p < 0.001) and those with no positive lymph nodes (91.4% versus 53.3%, p < 0.001). The probability of 5-year overall survival differed based on treatment modality (local excision: 93.6%, radical resection: 79.1%, observation alone: 77.1%; p < 0.001). On multivariable Cox regression, when compared to local excision, radical resection was not associated with a difference in overall survival but observation alone was associated with significantly worse OS (HR = 2.750, p < 0.001).
CONCLUSIONS
There is a significant difference in overall survival between patients who underwent local excision versus observation alone. Excision of the tumor should be offered to all patients with rectal neuroendocrine tumors who are appropriate surgical candidates, regardless of the tumor size.
背景
直肠类癌占消化道神经内分泌肿瘤的 20%，但对于此类疾病的最佳治疗方法仍存在争议。本研究旨在更好地确定直肠类癌患者的治疗方法。
方法
我们利用国家癌症数据库，分析了 2004 年至 2015 年间患有直肠类癌的患者。排除患有转移性疾病和治疗数据缺失的患者。我们使用 Kaplan-Meier 分析和对数秩检验，按肿瘤大小、治疗类型和阳性淋巴结存在情况对总生存率进行分层分析。采用 Cox 比例风险回归模型确定与总生存率相关的因素。
结果
共纳入 17448 例直肠类癌患者，其中 16531 例符合纳入标准。大多数患者的肿瘤直径≤10mm（9216 例，79.8%），约 90%的患者接受了局部切除术。肿瘤直径较小（≤10mm：94.1%；11-20mm：85.7%；>20mm：71.8%；p<0.001）和无阳性淋巴结的患者 5 年总生存率显著较高（91.4%比 53.3%，p<0.001）。不同治疗方式的 5 年总生存率也不同（局部切除术：93.6%；根治性切除术：79.1%；单纯观察：77.1%；p<0.001）。多变量 Cox 回归分析显示，与局部切除术相比，根治性切除术与总生存率无差异，但单纯观察与总生存率显著降低相关（HR=2.750，p<0.001）。
结论
与单纯观察相比，接受局部切除术的患者总生存率有显著差异。所有适合手术的直肠类癌患者均应行肿瘤切除术，无论肿瘤大小。
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