Ye Xiaorong, Wang Lifu, Xing Yongjun, Song Chengjun
Department of Trauma Surgery, The Lishui People's Hospital, 15 Dazhong Street, Lishui, 323000, Zhejiang, People's Republic of China.
BMC Gastroenterol. 2020 Oct 15;20(1):342. doi: 10.1186/s12876-020-01487-6.
Population-based analysis for the liver metastases of small bowel cancer is currently lacking. This study aimed to analyze the frequency, prognosis and treatment modalities for newly diagnosed small bowel cancer patients with liver metastases.
Patients with small bowel cancer diagnosed from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Binary logistic regression analysis was performed to determine predictors for the presence of liver metastases at diagnosis. Kaplan-Meier method and Cox regression analyses were performed for survival analyses.
A total of 1461 small bowel cancer patients with liver metastases at initial diagnosis were identified, representing 16.5% of the entire set and 63.9% of the subset with metastatic disease to any distant site. Primary tumor with poorer histological type, larger tumor size, later N staging, more extrahepatic metastatic sites, and tumor on lower part of small intestine had increased propensity of developing liver metastases. The combined diagnostic model exhibited acceptable diagnostic efficiency with AUC value equal to 0.749. Patients with liver metastases had significant poorer survival (P < 0.001) than those without liver metastases. In addition, combination of surgery and chemotherapy (HR = 0.27, P < 0.001) conferred the optimal survival for patients with adenocarcinoma, while the optimal treatment options for NEC and GIST seemed to be surgery alone (HR = 0.24, P < 0.001) and chemotherapy alone (HR = 0.08, P = 0.022), respectively.
The combined predictor had a good ability to predict the presence of liver metastases. In addition, those patients with different histologic types should be treated with distinct therapeutic strategy for obtaining optimal survival.
目前缺乏基于人群的小肠癌肝转移分析。本研究旨在分析新诊断的小肠癌肝转移患者的发生率、预后及治疗方式。
从监测、流行病学和最终结果（SEER）数据库中提取2010年至2015年诊断为小肠癌的患者。进行二元逻辑回归分析以确定诊断时肝转移存在的预测因素。采用Kaplan-Meier法和Cox回归分析进行生存分析。
共识别出1461例初诊时伴有肝转移的小肠癌患者，占全部病例的16.5%，占任何远处转移疾病亚组的63.9%。组织学类型较差、肿瘤较大、N分期较晚、肝外转移部位较多以及小肠下部肿瘤的原发性肿瘤发生肝转移的倾向增加。联合诊断模型表现出可接受的诊断效率，AUC值等于0.749。肝转移患者的生存率显著低于无肝转移患者（P < 0.001）。此外，手术和化疗联合（HR = 0.27，P < 0.001）为腺癌患者带来最佳生存，而神经内分泌癌（NEC）和胃肠道间质瘤（GIST）的最佳治疗选择似乎分别是单纯手术（HR = 0.24，P < 0.001）和单纯化疗（HR = 0.08，P = 0.022）。
联合预测指标具有良好的预测肝转移存在的能力。此外，对于不同组织学类型的患者，应采用不同的治疗策略以获得最佳生存。
